The principle of surgery of the parotid gland is adequate removal of the tumor with functional and anatomical preservation of all blanches of the facial nerve. There are two main surgical approaches to superficial or total conservative parotidectomy. Anterior approach and posterior approach. Preliminary identification of the main trunk of the facial nerve is probably the most favoured techniques, but identification of the peripheral blanches of the facial nerve, with subsequent Proximal dissection to the main trunk, is long established but less popular technique. We have prospectively experienced the low incidence of facial nerve damage in series of 55 conservative parotidectomies performed using the anterior approach. The techniques employed is described with a deport of results obtained in the belief that this approach warrants greater popularity and saute technique.
Facial Nerve ; Incidence ; Parotid Gland ; Prospective Studies

We report a patient with an unusual manifestation of Trichophyton violaceum infection, who lives in Seoul. An 8-year-old male presented an erythematous nodule on the lower eyelid of the left eye which had persisted for 10 weeks. On physical examination, there was no abnormality except a skin lesion on the eyelid. The skin biopsy of the nodule showed epidermal hyperplasia and granulomatous change in the upper dermis. The biopsy specimen yielded Trichophyton uiolaceum on culture. The skin lesion disappeared 2 months after administration of ketoconazole.
Biopsy ; Child ; Dermis ; Eyelids ; Granuloma* ; Humans ; Hyperplasia ; Ketoconazole ; Male ; Physical Examination ; Seoul ; Skin ; Trichophyton*

PURPOSE: Marginal fit is a very important factor considering the restoration's long-term success. However, adding porcelain to copings can cause distortion and lead to an inadequate fit which exposes more luting material to the oral environment and causes secondary caries. The purpose of this study was to compare the marginal fit of 2 different all-ceramic crown systems before and after porcelain veneering. This study was also intended to verify the marginal fit of crowns originated from green machining of partially sintered blocks of zirconia (Lava CAD/CAM system) and that of crowns obtained through machining of fully sintered blocks of zirconia (Digident CAD/CAM system). MATERIAL AND METHODS: 20 crowns were made per each system and the marginal fit was evaluated through a light microscope with image processing (Accura 2000) at 50 points that were randomly selected. Each crown was measured twice: the first measurement was done after obtaining a 0.5 mm coping and the second measurement was done after porcelain veneering. The means and standard deviations were calculated and statistical inferences among the 2 groups were made using independent t-test and within the same group through paired t-test. RESULTS: The means and standard deviations of the marginal fit were 61.52 +/- 2.88 micrometer for the Digident CAD/CAM zirconia ceramic crowns before porcelain veneering and 83.15 +/- 3.51 micrometer after porcelain veneering. Lava CAD/CAM zirconia ceramic crowns showed means and standard deviations of 62.22 +/- 1.78 micrometer before porcelain veneering and 82.03 +/- 1.85 micrometer after porcelain veneering. Both groups showed significant differences when analyzing the marginal gaps before and after porcelain veneering within each group. However, no significant differences were found when comparing the marginal gaps of each group before porcelain veneering and after porcelain veneering as well. CONCLUSION: The 2 all-ceramic crown systems showed marginal gaps that were within a reported clinically acceptable range of marginal discrepancy.
Ceramics ; Crowns ; Dental Porcelain ; Light ; Zirconium

Reconstruction of the soft tissue defects on the plantar foot continues to be a difficult challenges because of the unique anatomical features. It should endure constant weight loading or alternate stimulus of shoes while standing or walking. The methods used for reconstruction of the soft tissue defects on the plantar foot are skin graft, local flap, cross leg flap, myocutaneous flap, neurovascular island and free flap. However, it is verb difficult to find a proper method to reconstruct the soft tissue defect of the first toe plantar area. The ideal reconstruction should provide tissue as durable yet sensitive, provide tissue components similar to the original lost tissue, be reliable, result in a donor site that is well tolerated, and entail one operative procedure with minimal morbidity Although the medial plantar flap was initially described to surface heel defects, many surgeons haute used this flap as a cross leg flap or a free flap to recover the first toe plantar area. Its use has always required a secondary surgical procedure or a difficult technique. In order to overcome this inconvenience, we used the flap based on the principle of reversing the direction of blood flow in a distal vascular pedicle to restore a defect of the anteromedial aspect of the foot. We haute experienced 3 cases of reverse medial plantar flap for the reconstruction of the great toe plantar area. Good functional and aesthetic results were obtained.
Foot ; Free Tissue Flaps ; Heel ; Humans ; Leg ; Myocutaneous Flap ; Shoes ; Skin ; Surgical Procedures, Operative ; Tissue Donors ; Toes* ; Transplants ; Walking

Lumbosacral fixation or spinopelvic fixation is frequently required for the surgical treatment of neuromuscular scoliosis and degenerative lesions, trauma and tumor in the lumbosacral vertebrae. However, the establishment of stable fixation with these procedures is difficult due to the anatomic characteristics of the sacrum and this is even more problematic for the cases with long segmental fixation, severe instability and bone defects. Although the emergence of pedicle screws makes spinal fixation easier and more rigid, S1 pedicle screws alone do not provide enough stability for lumbosacral fixation. For the purposes of reinforcing lumbosacral fixation, procedures using rods or screws can be used: the procedures using rods include the Galveston method, the McCarthy S-rod and the Jackson intrasacral rod, and the procedures using screws include sacral alar screws, transdiscal screws and iliac screws. The purpose of this study was to ascertain the proper fixation methods, according to each indication, for spinopelvic fixation and we analyzed the advantages and drawbacks of each fixation method. In addition, the fixation method of iliac screws, which has recently become more popular, is presented in detail to enhance the availability and reduce the complication of this technique.
Sacrum ; Scoliosis ; Spine ; Succinates

STUDY DESIGN: A retrospective study. PURPOSE: To comparatively investigated the rate of the adjacent segment degeneration and the clinical outcomes in patients with spondylolytic spondylolisthesis, spinal stenosis or degenerative spondylolisthesis. OVERVIEW OF LITERATURE: There have been few studies reported on the adjacent segment degeneration following posterior lumbar interbody fusion(PLIF). Many risk factors for the adjacent segment degeneration following PLIF have been proposed. The range of decompression has been presented as one of the risk factors, yet controversial. METHODS: This study enrolled sixty-three patients who had been treated with single-level PLIF and who were followed up for more than two years. The patients were divided into 3 groups based on the preoperative diagnosis. We analyzed the difference between the preoperative and postoperative intervertebral disc heights of the superior adjacent segments. The incidence rates of instability and the clinical outcomes were comparatively analyzed between each group. RESULTS: The average age of the patients was 55.8 years in the spondylolytic spondylolisthesis group, 65.9 years in the degenerative spondylolisthesis group and 60.4 years in the spinal stenosis group. The average follow-up period was 44 months, 43 months and 42 months, respectively. At the last follow-up, compared to the preoperative period, the intervertebral disc height decreased in all three groups. A statistically significant decrease (p < 0.01) was observed only in the spondylolytic spondylolisthesis group and no significant difference was observed between each group (p = 0.41). The incidence rate of instability and the clinical outcome were not significantly different between each group. CONCLUSIONS: Spondylolytic spondylolisthesis with total laminectomy and single-level PLIF showed no significant difference in the superior adjacent segment degeneration and instability, and the clinical outcome as compared to that of partial laminectomy with single-level PLIF for treating degenerative spondylolisthesis or spinal stenosis.
Decompression ; Follow-Up Studies ; Humans ; Incidence ; Intervertebral Disc ; Laminectomy ; Preoperative Period ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Spondylolisthesis

The elimination of most anticholinesterases depends on the kidney, even if the main organ for their metabolism is the liver. Renal excretion of pyridostigmine, edrophonium and neostigmine accounts for 15%, 70% and 50%, respectively. In the absence of renal function, the serum half-life of neostigmine is prolonged, its plasma clearance is decreased However, the pharmacodynamics of neostigmine have not been determined in renal failure. This study was designed to compare the neostigmine dynamics in 18 patients with normal renal function to that in 18 patients with renal failure(Group I & II, respectively). Using the flexor carpi ulnaris EMG via ulnar nerve stimulation with Train-Of-Four(TOF) under the constant infusion of vecuronium to produce about 85%-twitch depression, the responses of neostigmine with three different doses were obtained. The results are follows; 1) The constant infusion rates of vecuronium to maintain sbout 15&-twitch height prior to the administration of neostigmine showed no significant difference between two groups. 2) Immediately prior to each dose of neostigmine, the mean values of twitch heights were 11.7 to 13.7%. 3) There was no significant difference in the onset time, maximum twitch responses and antagonism effects between two groups in respect to each same dose of nesotigmine. 4) The duration of neostigmine with the half of ED only in Group II was significantly longer than that in Group I, even if the durations with the other doses in Group II were not significantly longer than those in Group L These results suggest that the reversal effect of neostigmine to vecuronium-induced block- ade may be outlasted in patients with renal failure and the prolongation of neostigmine effeet may render some benefits to reverse the relaxants which have the limitation of its elimination in this patients.
Cholinesterase Inhibitors ; Depression ; Edrophonium ; Half-Life ; Humans ; Kidney ; Liver ; Metabolism ; Neostigmine* ; Neuromuscular Blockade* ; Plasma ; Pyridostigmine Bromide ; Renal Insufficiency* ; Ulnar Nerve ; Vecuronium Bromide*

PURPOSE: The detection of bladder cancers by noninvasive techniques remains an unsolved problem. We evaluate the availability of an immunoassay for urinary nuclear matrix protein, NMP 22, as an indicator for transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Three groups of subjects participated in this trial of NMP 22: 22 patients with transitional cell carcinoma (group 1), 12 patients with urinary tract infection (group 2) and 31 healthy volunteers (group 3). NMP 22 was determined by ELISA using a commercial test kit (NMP 22 Test Kit, Matritech Inc., USA), We compared urinary NMP 22 levels to the grade, stage, cytology and DNA flowcytometry of transitional cell carcinoma of bladder. RESULTS: NMP 22 values in these 3 groups were significantly different (group 1, median 24.81 U/mL; group 2, median 8.41 U/mL; and group 3, median 5.12 U/mL; Mann-Whitney U test for differences between 3 medians, p < 0.05). The patients with transitional cell carcinoma had significantly greater urinary NMP 22 levels than those with no evidence of tumor (Mann-Whitney U test for differences between 2 medians, p<0.01). There was no zelationship between the urinary NMP 22 levels and tumor grade, stage, cytology or DNA flowcytometry. CONCLUSIONS: It is possible that urinary NMP 22 could improve the detection of bladder transitional cell carcinoma.
Carcinoma, Transitional Cell* ; DNA ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Humans ; Immunoassay ; Nuclear Matrix* ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Tract Infections

PURPOSE: The purpose of this study was to explore Korean mothers' experiences of caregiving for their adult children with schizophrenia. METHOD: A iterative descriptive qualitative research design was used to understand and explain the caregiving experience from the perspective of mothers. The data were collected by individual in-depth interviews and one focus group interview from 11 mothers. The ages of the participants ranged from 50 to 60 years old and the ages of their sick children ranged from late 20s to early 40s. RESULTS: Three major themes were identified from qualitative thematic analysis: (a) "emotional debris from the disease," (b) "the disease that makes mothers dumb" (c) "space of rational reason." CONCLUSIONS: This study would provide health care professionals insights in establishing intervention for mothers by deeply understanding the process of recognition and acceptance of their children with schizophrenia.
Schizophrenia/*therapy ; Mothers/*psychology ; Middle Aged ; Male ; Humans ; Female ; Caregivers/*psychology ; Adult

PURPOSE: The purpose of this study was to explore Korean mothers' experiences of caregiving for their adult children with schizophrenia. METHOD: A iterative descriptive qualitative research design was used to understand and explain the caregiving experience from the perspective of mothers. The data were collected by individual in-depth interviews and one focus group interview from 11 mothers. The ages of the participants ranged from 50 to 60 years old and the ages of their sick children ranged from late 20s to early 40s. RESULTS: Three major themes were identified from qualitative thematic analysis: (a) "emotional debris from the disease," (b) "the disease that makes mothers dumb" (c) "space of rational reason." CONCLUSIONS: This study would provide health care professionals insights in establishing intervention for mothers by deeply understanding the process of recognition and acceptance of their children with schizophrenia.
Schizophrenia/*therapy ; Mothers/*psychology ; Middle Aged ; Male ; Humans ; Female ; Caregivers/*psychology ; Adult