Usually the open rhinoplasty is used to correct the plunging nasal tip, but it can increase patient's psychological trauma and lengthen the operation time. In this study, the authors present a simple and effective surgical procedure to correct the plunging nasal tip with minimal morbidity. Between April 2005 and February 2006, we performed our nasal tip plasty in 6 patients who were concerned about the long nose with plunging nasal tip. We used the suture method after cephalic resection of the alar cartilage and caudal resection of the septal cartilage through endonasal approach. After that, we evaluated the nasal profile and compared the result with preoperative photographs. We followed these patients for 1 to 4 months. We could achieved good nasal tip projection, improvement of the columellolabial angle and shortening of long nose. The result were relatively satisfactory and there were no complications such as visible scar, alar deformity or asymmetry. Our tip plasty through endonasal approach could reform the plunging nasal tip properly and easily without external scar. We believe that this procedure could be applicable for correcting the plunging nasal tip and an alternative technique which helps to form the harmonious nasal profile with augmentation rhinoplasty.
Cartilage ; Cicatrix ; Congenital Abnormalities ; Humans ; Nose ; Rhinoplasty ; Sutures

BACKGROUND AND OBJECTIVES: The pathologic Q wave was once considered to be a sign of transmural myocardial infarction (MI), but the exact meaning of the pathologic Q wave remains to be elucidated. To evaluate the meaning of the pathologic Q wave using magnetic resonance imaging (MRI) investigations, which has recently emerged as a state-of-the-art diagnostic modality within cardiology. SUBJECTS AND METHODS: Thirty eight consecutive patients with acute myocardial infarction were enrolled in this study. MRI and coronary angiography were performed in all patients during their admission. A 32 segment model was used to analyze the MRI findings. Just before MRI, the electrocardiograms of all the patients were checked and the presence of the pathologic Q wave evaluated. The ischemic territories in each patient were quantified by the number of dysfunctional segments. Myocardial necrosis was determined by the area of delayed hyperenhancement in contrast enhanced MRI, and the myocardial necrosis index per segment was defined as the ratio of the hyperenhanced area to that of the entire segment. The total necrosis index was defined as the sum of all the myocardial necrosis indices in a patient, and the average necrosis index of dysfunctional segment (ANI) was calculated from the total necrosis index/number of dysfunctional segments in a patient. The transmurality of infarction was also assessed. RESULTS: Of all 38 patients, 26 showed a pathologic Q wave on ECG (Group A), whereas the other 12 did not (Group B). The number of dysfunctional segments, total necrosis index and frequency of transmural infarction (defined by infarct transmurality> or = 75% of wall thickness) were no different between the two groups. The infarct transmurality over 25 or 50% and ANI were significantly different between the two groups. In a multivariate analysis, an infarct transmurality over 50% and ANI were significant factors in determining the presence of a pathologic Q wave. CONCLUSION: By an in vivo analysis of myocardial necrosis, as determined by MRI in acute myocardial infarction, an infarct transmurality over 50% and average necrosis index of dysfunctional segments (ANI) might be significant factors in the genesis of a pathologic Q wave.
Cardiology ; Coronary Angiography ; Electrocardiography ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Myocardial Infarction* ; Necrosis

Aortic coarctation is usually diagnosed and repaired in childhood and early adulthood. Survival of a patient with an uncorrected coarctation to more than 70 years of age is extremely unusual, and management strategies for these cases remain controversial. We present a case of a 75-year-old woman who was first diagnosed with aortic coarctation and severe aortic valve stenosis 5 years ago and who underwent a successful one-stage repair involving valve replacement and insertion of an extra-anatomical bypass graft from the ascending to the descending aorta.
Aged ; Aorta, Thoracic ; Aortic Coarctation ; Aortic Valve Stenosis ; Female ; Humans ; Thoracic Surgical Procedures ; Transplants

Primary cardiac malignancy is very rare. Angiosarcoma is the most frequent malignant cardiac tumor and associated with a very unfavourable outcome. We report the case of an cardiac angiosarcoma complicated with cardiac tamponade revealed by echocardiography with pericardiocentesis and confirmed histopathologically in a 25 years old man.
Adult ; Cardiac Tamponade* ; Echocardiography ; Heart Neoplasms ; Hemangiosarcoma* ; Humans ; Pericardiocentesis

BACKGROUND AND OBJECTIVES: We investigated the effectiveness of balloon dilatation of homograft conduits in the pulmonary position in delaying surgical replacement. SUBJECTS AND METHODS: We reviewed the medical records of patients who underwent balloon dilatation of their homograft in the pulmonary position from 2001 to 2015. The pressure gradient and ratio of right ventricular pressure were measured before and after the procedure. The primary goal of this study was to evaluate the parameters associated with the interval to next surgical or catheter intervention. RESULTS: Twenty-eight balloon dilations were performed in 26 patients. The median ages of patients with homograft insertion and balloon dilatation were 20.3 months and 4.5 years, respectively. The origins of the homografts were the aorta (53.6%), pulmonary artery (32.1%), and femoral vein (14.3%). The median interval after conduit implantation was 26.7 months. The mean ratio of balloon to graft size was 0.87. The pressure gradient through the homograft and the ratio of right ventricle to aorta pressure were significantly improved after balloon dilatation (p<0.001). There were no adverse events during the procedure with the exception of one case of balloon rupture. The median interval to next intervention was 12.9 months. The median interval of freedom from re-intervention was 16.6 months. Cox proportional hazards analysis revealed that the interval of freedom from re-intervention differed only according to origin of the homograft (p=0.032), with the pulmonary artery having the longest interval of freedom from re-intervention (p=0.043). CONCLUSION: Balloon dilatation of homografts in the pulmonary position can be safely performed, and homografts of the pulmonary artery are associated with a longer interval to re-intervention.
Allografts* ; Angioplasty, Balloon ; Aorta ; Catheters ; Dilatation* ; Femoral Vein ; Freedom ; Heart Ventricles ; Humans ; Medical Records ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Rupture ; Transplants ; Ventricular Pressure

BACKGROUND: Pulmonary hypertension caused by chronic pulmonary embolism is underrecognized and carries a poor prognosis. Medical therapy is generally unsatisfactory and palliative. With the improvemet of operative technique and postoperative management, pulmonary endarterectomy has been the treatment of choice for this condition. MATERIAL AND METHOD: Between January 2001 and Decomber 2005, eleven patients were received pulmonary endarterectomy. All patients had chronic dyspnea and exercise intolerance. Diagnosis was made with cardiac echocardiography, lung perfusion scan and computed tomography. Before the operation, Greenfield vena cava filter were placed in all patient except one. Deep hypothermic circulatory arrest was used for the distal-most portion of the endarterectomy procedure. More than moderate degree of tricuspid reguirgitation was repaired during operation. RESULT: There was no early and late death. Right ventricular systolic pressure was reduced significantly after operation from 91+/-21 mmHg to 40+/-17 mmHg on echocardiography (p=0.001). NYHA class and tricuspid reguirgitaion were improved postoperatively. Although mild reperfusion injury in three case and postoperative delirium in one case were observed, all of them recovered without complication. CONCLUSION: Pulmonary thromboendarterctomy offers to patient an acceptable morbidity rate and anticipation of clinical improvement. This method is safe and effective operation for pulmonary hypertension caused by chronic pulmonary thromboembolism.
Blood Pressure ; Circulatory Arrest, Deep Hypothermia Induced ; Delirium ; Diagnosis ; Dyspnea ; Echocardiography ; Endarterectomy* ; Humans ; Hypertension, Pulmonary* ; Lung ; Perfusion ; Prognosis ; Pulmonary Embolism* ; Reperfusion Injury ; Vena Cava Filters

BACKGROUND: Pulmonary hypertension caused by chronic pulmonary embolism is underrecognized and carries a poor prognosis. Medical therapy is generally unsatisfactory and palliative. With the improvemet of operative technique and postoperative management, pulmonary endarterectomy has been the treatment of choice for this condition. MATERIAL AND METHOD: Between January 2001 and Decomber 2005, eleven patients were received pulmonary endarterectomy. All patients had chronic dyspnea and exercise intolerance. Diagnosis was made with cardiac echocardiography, lung perfusion scan and computed tomography. Before the operation, Greenfield vena cava filter were placed in all patient except one. Deep hypothermic circulatory arrest was used for the distal-most portion of the endarterectomy procedure. More than moderate degree of tricuspid reguirgitation was repaired during operation. RESULT: There was no early and late death. Right ventricular systolic pressure was reduced significantly after operation from 91+/-21 mmHg to 40+/-17 mmHg on echocardiography (p=0.001). NYHA class and tricuspid reguirgitaion were improved postoperatively. Although mild reperfusion injury in three case and postoperative delirium in one case were observed, all of them recovered without complication. CONCLUSION: Pulmonary thromboendarterctomy offers to patient an acceptable morbidity rate and anticipation of clinical improvement. This method is safe and effective operation for pulmonary hypertension caused by chronic pulmonary thromboembolism.
Blood Pressure ; Circulatory Arrest, Deep Hypothermia Induced ; Delirium ; Diagnosis ; Dyspnea ; Echocardiography ; Endarterectomy* ; Humans ; Hypertension, Pulmonary* ; Lung ; Perfusion ; Prognosis ; Pulmonary Embolism* ; Reperfusion Injury ; Vena Cava Filters

PURPOSE: The presence of epicanthal fold and the absence of supratarsal fold are characteristics of Korean eyelids. There has been many surgical procedures to eliminate medial epicanthal fold but those procedures focus on the lengthening of horizontal palpebral fissure and the shortening of intercanthal distance so that the shape of eye had tendency to be sharp. The authors suggest that the supermedial shifting of epicanthal fold enhance the aesthetic result. METHODS: From Sep 2006 to May 2007, total 17 women(mean age 22) with Type III epicanthal fold underwent epicanthoplasty using author's modified Uchida method. The design for epicanthoplasty was drawn superolaterally along epicanthal fold and split V-W plasty was done to shift the epicanthal fold superomedially. Also non-incisional double-eyelid operation was underwent. RESULTS: The epicanthal fold was shifted in superomedially, intercanthal distance was shortened and double-eyelid was achieved. The patients were satisfied with the result and no major complication was noted. CONCLUSION: This method can be effective in correcting the epicanthal fold of Korean eyelid by shifting the epicanthal fold superomedially to make the shape of eye aesthetically without noticeable scar.
Cicatrix ; Eyelids ; Humans ; Sterilization, Tubal*

BACKGROUND AND OBJECTIVES: The objective of this study was to analyze cardiovascular risk factors in adults with congenital heart disease (ACHD). SUBJECTS AND METHODS: The subjects for this study comprised 135 patients, aged 18 years and above, who visited the ACHD clinic at the Samsung Medical Center and 135 adults with a structurally normal heart who were randomly selected from the Center for Health Promotion during the same period. For the analysis, the ACHD group was further divided into an ACHD group that underwent correction by cardiac surgery and a cyanotic group. RESULTS: The mean (standard diviation) age (years) of patients in the surgically corrected group was 48.4 (10.9) years, while that of patients in the cyanotic group was 43.1 (9.0) years and that of patients in the control group was 47.1 (10.3) years (p=0.042). The adjusted odds ratios (ORs) for past smoking, hypertension, diabetes mellitus, hypercholesterolemia, obesity, and metabolic syndrome were significantly higher in the surgically corrected patients than in the controls. However, the ORs for all variables excluding past smoking were significantly lower in the cyanotic group compared with the control group. After adjustment for age, gender, smoking, alcohol use, and exercise, the ORs for metabolic syndrome were 0.46 (0.35-0.57, p<0.001) and 1.48 (1.14-1.92, p=0.003) in the cyanotic and surgically corrected groups, respectively. CONCLUSION: Cardiovascular risk factors need to be considered in surgically corrected ACHD patients as well as in adults with a structurally normal heart. A further study with a long-term follow-up is needed for developing guidelines for prevention.
Adult* ; Diabetes Mellitus ; Follow-Up Studies ; Health Promotion ; Heart ; Heart Defects, Congenital* ; Humans ; Hypercholesterolemia ; Hypertension ; Metabolic Syndrome X ; Obesity ; Odds Ratio ; Risk Factors* ; Smoke ; Smoking ; Thoracic Surgery

BACKGROUND AND OBJECTIVES: Since echocardiography became a routine diagnostic tool, pericardial effusion has become a common clinical finding. The major causes of hemorrhagic pericardial effusion are malignancy and tuberculosis. However, it was unknown to the use of biochemical analysis of pericardial fluid and serum, for differentiation of malignancy from tuberculosis. To evaluate this, we investigated the biochemical analysis of pericardial fluid and serum in relation to the causes of pericardial tamponade. SUBJECTS AND METHODS: 46 patients who were admitted to Pusan National University Hospital from January 1, 1995, to April 30, 2002, and underwent both a pericardiocentesis and a pericardiostomy for the relif of cardiac tamponade, were included in this study. the pericardial fluid was routinely analyzed for the following: gross appearance, cell count, glucose, total protein(P), lactate dehydrogenase(LDH), cytology, gram stain, cultures for bacteria and mycobacterium, pericardial fluid to serum ratios of total protein and lactate dehydrogenase,(p/s TP, p/s LDH, respectively). RESULTS: f the 46 patients who underwent both pericardiocentesis and pericardiostomy, for the relief of cardiac tamponade, 33 patients(71.7%) had hemorrhagic pericardial effusion. The common causes of hemorrhagic pericardial effusion were malignancy(51.5%) and tuberculosis(33.3%) but, those of nonhemorrhagic pericardial effusion were idiopathic (38.5%). Cell counts were higher in hemorrhagic than nonhemorrhagic group(p=.029). Serum LDH(sLDH) was higher in malignant than tuberculous group(p=.001) but, serum total protein(sTP) was higher in tuberculous group(p=.004). Compared malignant group with tuberculosis group in patients with hemorrhagic pericardial effusion, p/s ratio of LDH and sTP were higher in tuberculous group (p=.029, p=.017), but sLDH was higher in malignant group(p=0.002). CONCLUSION: It is difficult to differentiate tuberculosis from malignancy only on the basis of the biochemical analysis of pericardial fluid in hemorrhagic pericardial effusion. However, the analysis of both pericardial fluid and serum may make it possible to evaluate the cause of pericardial effusion.
Bacteria ; Blood Chemical Analysis ; Busan ; Cardiac Tamponade ; Cell Count ; Echocardiography ; Glucose ; Humans ; Lactic Acid ; Mycobacterium ; Pericardial Effusion* ; Pericardial Window Techniques ; Pericardiocentesis ; Tuberculosis