The goal of cleft lip surgery is to reconstruct normal shape of the lip. To acomplish this goal, various operative method were contrived and concept of the method decided the shape of reconstructed lips. According to the operative result, some operative methods were disappeared or have been developed with a little modifiation. Traditional Millard's rotation-advancement method for unilateral cleft lip patients is largely accepted and developed as proper method for acquiring these functional and anatomic purposes. As a trial for this development, Mulliken add some modifications. He uses exaggerated high rotation incision and it lengthens into midcolumella without backcut. Also he dosen't steal from alar base or lateral lip for vertical height. C-flap is used to lengthen the affected columella and upper lip. The isolated orbicularis oris muscle is coaptated each other for more functional result. With supraperichondral dissection of alar cartilage and transpositioning of caudal septum, he performs synchronous repair of cleft lips, nose and sometimes alveolus. It is still debated when is most suitable age for surgical correction of nasal deformity of cleft lip patients. Done at the time of primary lip repair, there are both some apprehension and inducement. The former are based on technical difficulties due to shortage and fragility of neonatal tissue and possibility of progressive deformities with growing because of iatrogenic injuries to the alar cartilages. But te latter is rationalized because early reposition of deformed nasal cartilage in proper position would induce more natural growth of nasal structures. Some long-term follow up reports reveal the early operation innocent of any growth deterioration. Mulliken treats his cleft lip patient for separated lip and nasal deformities with single operation, and does gingiovoperiosteal alveoloplasty at the same time if necessary. He uses Latham appliance from 4 to 6 week after birth in case of severly collapsed lateral alveolar segment or wide alvolar gap, and perform the definitive opertation at the age of 4 to 6 months. I use lip adhension method to correct more than 10 mm alveolar gap without severe collapse of lateral alveolar segment, but if lateral segment was severely collapsed and away from alvolar arch, I apply the Latham appliance somewhat modificate from original type, which has a metal ring fastened at the front limb of appliance for rubber banding to coaptate easily. I have experienced repair of cleft lip by Mulliken's concept with some modification of my own to 44 cases of unilateral cleft lip patients and conclude that it was very flexible method. Doing with synchonous repair of cleft lip nose, we could get harmonious lip and nose with symmetric nostril sill, cupid's bow and red line. Columella was lengthened primarily. Normal growth of nose was anticipated by anatomic repositioning of alar septal cartilage.
Alveoloplasty ; Cartilage ; Cleft Lip* ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Lip ; Nasal Cartilages ; Nose ; Parturition ; Rubber

Trichoepithelioma. so named by Jarisch(1894), is a rare benign neoplasm of the skin on face and eyelid. The solitary type which is the most usual form seen in the eyelid occurs mainly in adult, on the other hand multiple type begin to appear at adolescence or puberty as a dominantly inherited condition. A 21 year-old korean female was found to have trichoepithelioma in her left lower eyelid mangm.
Adolescent ; Adult ; Eyelids ; Female ; Hand ; Humans ; Puberty ; Skin ; Young Adult

After aseptic or septic meningitis, some neurologic complications such as convulsions, delirium, rigidity, cerebral infarctions and cerebral hemorrhage can be developed. The cerebral infarction after meningitis is caused by arterial or venous occlusions. Involvement of small perforating arteries leads to ganglionic infarcts while severe sapsm of major vessels may lead to massive infarctions in the distribution of middle and/or anterior cerebral arteries. Cortical venous and/or dural thrombosis (especially in the superior sagittal sinus) produces typical features, including multiple areas of white matter hemorrhagic infarction. These neurologic complications are common in bacterial meningitis and very rare in aseptic meningitis. We experienced a case of cerebral infarction in MCA/ACA territory and subdural hemorrhage in occipital lobe after aseptic meningitis in 10 month-old-boy. We report a case with a brief review of related literature.
Anterior Cerebral Artery ; Arteries ; Cerebral Hemorrhage ; Cerebral Infarction* ; Delirium ; Ganglion Cysts ; Hematoma, Subdural* ; Infarction ; Meningitis ; Meningitis, Aseptic* ; Meningitis, Bacterial ; Occipital Lobe ; Seizures ; Thrombosis

Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.
Cardiomyopathies* ; Catecholamines ; Child, Preschool ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Hypertension ; Myocarditis ; Neuroblastoma*

A retrospective study is reported on 96 eyes treated by pars plana vitrectomy and intravitreal silicone oil tamponade for treatment of complicated retinal detachment to evaluate ocular complications secondary to intravitreal silicone oil complete retinal reattachment occurred in 59(61.5%) of 96 eyes at initial surgery. Recurrent retinal detachment and recurrent proliferative vitreoretinopathy occurred in 19(32.3%) and 15(25.4%) of 59 eyes respectively. The major complications associated with intravitreal silicone oil were cataract(96.6% of phakic eyes) and keratopathy(29.2%) and their peak onset was around 3 months after intravitreal silicone oil injection. Other complications were intraocular pressme elevation, hypotony, hyphema, fibrin reaction in anterior chamber, etc. These findings suggest that even though intravitreal silicone oil injection is a valid procedure for treatment of complicated retinal detachment, its removal is recommended after about 3 months before development of vision-threatening complicatoins such as cataract and keratopathy.
Anterior Chamber ; Cataract ; Fibrin ; Hyphema ; Retinal Detachment ; Retinaldehyde ; Retrospective Studies ; Silicone Oils* ; Vitrectomy ; Vitreoretinopathy, Proliferative

Background: It is well known that the addition of CO2 gas during cardiopulmonary bypass (CPB) can increase cerebral blood flow (CBF). In this study, we tried to find whether the increase of CBF by CO2 gas could be expressed on the measurement of body temperatures. Methods: This study included 22 adult patients who underwent CPB with moderate hypothermia and were assigned randomly to two groups by adding CO2 gas (CO2 group and Air group). We measured each tympanic (TM), nasopharyngeal (NP), oral, forehead, finger, rectal and CPB arterial line temperatures of CPB circuit for 20 times during cooling in every one minute for 20 minutes and during rewarming every two minutes for 40 minutes. Results: During cooling and rewarming, the TM, NP and oral temperatures changed more rapidly than the rectal and finger temperatures. In TM temperature, as time changed, the percent changes of temperature varied more prominently in the CO2 gas group than in the Air group. The statistical differences were significant especially during 13 minutes to 20 minutes in cooling and 8 minutes to 20 minutes during rewarming. Conclusion: From this data, we can postulate the effect of CO2 gas on CBF indirectly by measuring several sites of body temperatures.
Adult ; Body Temperature* ; Carbon Dioxide ; Cardiopulmonary Bypass* ; Fingers ; Forehead ; Humans ; Hypothermia ; Rewarming* ; Vascular Access Devices

A 53-year-old woman developed a psinful erythematous papular skin eruption around the biting site by a tick on the left lower abdomen. A excision biopsy specimen from the skin lesion showed perivsscular infiltration of inflammatory cells composed mainly of neutrophiles, lymphocytes, and a few eosinophiles and histiocytes throughout the dermis. Some of the vessels were dilated with protruding and proliferated endothelial cells. The tick was identified as an adult female of Ixodes nipponensis by the scanning electron microscopic examination.
Abdomen ; Adult ; Biopsy ; Dermis ; Endothelial Cells ; Eosinophils ; Female ; Histiocytes ; Humans ; Ixodes* ; Lymphocytes ; Middle Aged ; Neutrophils ; Skin ; Tick Bites* ; Ticks*

Airway management is still perceived as the greatest patient safety issue and the key task that anesthesiologists perform. Management includes mask ventilation, use of a laryngoscope, and the endotracheal intubation and extubation of the patient. Difficulty can be encountered at any of these stages, and can be a major cause of anesthesia-related morbidity and mortality. Competence in airway management requires knowledge of the anatomy and physiology of the airway, ability to access the patient's airway for the anatomic features that correlate with difficulties in airway management, skill with the many devices used in airway management, including a variety of recently-introduced airway tools, and the appropriate application of the sophisticated algorithm for difficult airway management. Development and clinical distribution of supraglottic airway devices and their enhancement, as well as the broad acceptance of awake fiber-optic intubation, has led to profound changes in the strategy for managing a difficult airway. Including the American Society of Anesthesiologists, many countries have developed their own airway management algorithm these days. Nevertheless, massive national and international deficits still exist in implementing these guidelines into practice as well as the implicated structural requirements with respect to education, reflection, team building and equipment concerning each individual institution. In regard to this situation, it is the recommendation of the author that our country develop and institute such a standardized system of airway management.
Airway Management* ; Education ; Hospital Distribution Systems ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Masks ; Mental Competency ; Mortality ; Patient Safety ; Physiology ; Ventilation

PURPOSE: To evaluate the levels of vascular endothelial growth factor (VEGF) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and to find any correlation between clinical and fundus findings, grade of PDR, post-operative complications and surgical outcomes. METHODS: Using ELISA, the vitreous concentration of VEGF was measured in 74 patients with PDR who had undergone vitrectomy and in 13 control patients. RESULTS: The pre-operative levels of VEGFin the vitreous of the PDR patients was significantly increased compared with those of the control and with the post-operative levels. The pre-operative VEGF concentration in the vitreous of the PDR patients was correlated with the duration of diabetes and the severity of proteinuria, but not with the type of diabetes, level of HbA1c, hypertension and BUN/creatinine levels. The severity of PDR was also correlated with pre-operative VEGF levels, especially in NVD, NVE and NVI, but was not correlated with vitreous hemorrhage and fibrous proliferation elsewhere. There was negative correlation with the severity of retinal detachments. The vitreous levels of VEGF in PDR were significantly lower in those who had received previous laser photocoagulation than in those who did not. The VEGF levels were also significantly elevated in patients who developed NVI or NVG in the post-operative period. The changes of visual acuity after vitrectomy in the PDR patients were not correlated with vitreous levels of VEGF. CONCLUSIONS: These results show that VEGF is related to intraocular angiogenesis, progression of PDR and post-operative complications such as NVI or NVG, and that panretinal photocoagulation could prevent the progression of PDR.
Diabetic Retinopathy* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hypertension ; Light Coagulation ; Proteinuria ; Retinal Detachment ; Vascular Endothelial Growth Factor A* ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

PURPOSE: To evaluate the clinical results and prognostic factors that predict final visual outcome in eye with posterior segment metallic foreign body(FB) managed by primary pars plana vitrectomy. METHODS: Twenty-nine patients with posterior segment FBs managed by pars plana vitrectomy were reviewed retrospectively. To determine prognostic factors for visual outcomes, variables including ocular findings at presentation, initial visual acuity(VA), location, size and weight of FBs, site of entrance, location of intraretinal lesion, mechanisms of injury and FB removal time were compared with final visual acuity. RESULTS: After a mean follow up of 19.2 months, 15 eyes(52%) achieved VA of 20/40 or better and 5 eyes(17%) showed decreased VA compared to the initial VA. Prognostic factors for the final VA of 20/40 or better included the weight of FBs less than 20 mg, negative findings of retinal detachment and endophthalmitis. Prognostic factors for the final VA of 20/200 or less included the size of FBs more than 4mm, the weight of FBs more than 20 mg, intraretinal FBs, nonhammering as the mechanism of injury. CONCLUSIONS: The predictors of the final VA were the size, the weight and the location of FBs, mechanisms of injury, preoperative negative findings of retinal detachment and endophthalmitis. These factors will be helpful for planning surgery and predicting the prognosis.
Endophthalmitis ; Follow-Up Studies ; Foreign Bodies* ; Humans ; Prognosis ; Retinal Detachment ; Retrospective Studies ; Visual Acuity ; Vitrectomy*