This report describes osteotomy and iliac bone graft for malunion caused by failed mandibular fracture reduction. A 27-year-old man was referred 3 months after a motor vehicle accident. At another hospital, two operations had been performed for symphyseal fracture using two resorbable plates. Malocclusion was noted, and panoramic radiography and computed tomography revealed a misaligned dental arch, with a 9.37-mm gap between the central and the lateral incisor of the left mandible. A wafer was made from the patient’s dental model, and a maxillary arch bar was applied. Through a lower gingivolabial incision, osteotomy was performed between the malunited symphyseal fracture segments. Both segments were reduced to their original position using the wafer and fixed with titanium miniplates via intermaxillary fixation (IMF). The intersegmental gap was filled with cancellous bone from the iliac crest. The gingival defect was covered with a mucosal transposition flap from the gingivolabial sulcus. IMF and the wafer were maintained for 5 and 9 weeks, respectively. At postoperative week 13, the screws were removed from the mandible and satisfactory occlusion was noted. His mouth opening improved from 2.5 to 3 finger breadths (40 mm). This case demonstrates the need for sufficient IMF when using resorbable plates.

Reconstruction method choice in recurrent head and neck cancer depends on surgical history, radiation therapy dosage, conditions of recipient vessels, and general patient condition. Furthermore, when defects are multiple or three dimensional in nature, reconstruction and flap choice aimed at rebuilding the functional structure of the head and neck are difficult. We experienced successful reconstruction of recurrent laryngeal cancer requiring reconstruction of esophageal and tracheostomy stroma defects using a chimeric two-skin anterolateral thigh flap with a single pedicle.
Esophagus ; Free Tissue Flaps ; Head ; Head and Neck Neoplasms ; Humans ; Laryngeal Neoplasms ; Methods ; Neck ; Thigh ; Tracheostomy

Stevens-Johnson syndrome (SJS) is a rare disease in which extensive toxic epidermolysis occursafter medication. Skin and mucous membranes are involved in about 90% of SJS cases, and webbingof mouth corners (microstomia) may occur when they are affected. Few reports have been issuedon microstomia in SJS, and no consensus has been reached regarding treatment methods,timings, or results. We encountered a case of microstomia following SJS after ofloxacin medicationin a 22-year-old woman treated by commissuroplasty using a lozenge-shaped excision. Wepresent an appropriate correction method and surgical timing for microstomia following SJS.

The immunosuppression significantly increases the risk for acquiring opportunistic infections due to bacteria, viruses, fungi, and protozoa. These opportunistic infections are the major source of morbidity and mortality in transplanted patients. Cytomegalovirus and Aspergillus are important infectious agents in renal transplant recipients. The onset of these diseases follows the period of maximal immunosuppression for the prevention and treatment of acute rejection. Cytomegalovirus infection can suppressed immunity in renal transplant recipient and associated with other opportunistic infections. We experienced a case of Aspergillus and Cytomegalovirus pneumonia after renal transplantation. This 45-year-old woman had undergone renal transplantation. About 1 months later, she presented with dry cough and mild fever. Chest radiographs revealed multifocal patchy and conglomerated consolidation on both lung field, especially lower lung field. The invasive aspergillosis and cytomegalovirus pneumonia was diagnosed by open lung biopsy. Her condition was progressively aggravated despite amphotericin B and ganciclovir therapy and expired 53 days after renal transplantation.
Amphotericin B ; Aspergillosis ; Aspergillus ; Bacteria ; Biopsy ; Cough ; Cytomegalovirus Infections ; Cytomegalovirus* ; Female ; Fever ; Fungi ; Ganciclovir ; Humans ; Immunosuppression ; Kidney Transplantation* ; Lung ; Middle Aged ; Mortality ; Opportunistic Infections ; Pneumonia* ; Radiography, Thoracic ; Transplantation

BACKGROUND: Mesial temporal sclerosis (MTS) is a well-known cause of temporal lobe epilepsy. Coexistence with cortical dysplasia (CD) has been reported, but its role is not well recognized. This study aims to determine whether there is any difference about clinical feature and surgical outcome between patients with MTS and coexistent CD (group 1) and patients with isolated MTS (group 2). METHODS: Retrospectively, surgical series of 45 patients (male:22, female:23) diagnosed as temporal lobe epilepsy were reviewed. We excluded patients who had another pathology (e. g., tumor, vascular malformation) except MTS or CD. The pathology, case histories, interictal EEG, and surgical outcome were compared. RESULTS: There was a tendency for group 1 patients to have earlier seizure onset age (10.9+/-6.35 versus 14.5+/-6.03, p=0.06) There was no statistically significant difference in the history of febrile convulsions (68.4% versus 53.8%, p>0.16) No statistically significant difference between groups were also found in disease duration, the head trauma/mental retardation history, seizure frequency, interictal EEG, and surgical outcome. CONCLUSIONS: CD in MTS appears to have an influence on seizure onset. The relationships among CD, febrile convulsion, and mesial temporal sclerosis must be more investigated.
Age of Onset ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Head ; Humans ; Malformations of Cortical Development* ; Pathology* ; Retrospective Studies ; Sclerosis* ; Seizures ; Seizures, Febrile ; Temporal Lobe*

BACKGROUND: Mesial temporal sclerosis (MTS) is a well-known cause of temporal lobe epilepsy. Coexistence with cortical dysplasia (CD) has been reported, but its role is not well recognized. This study aims to determine whether there is any difference about clinical feature and surgical outcome between patients with MTS and coexistent CD (group 1) and patients with isolated MTS (group 2). METHODS: Retrospectively, surgical series of 45 patients (male:22, female:23) diagnosed as temporal lobe epilepsy were reviewed. We excluded patients who had another pathology (e. g., tumor, vascular malformation) except MTS or CD. The pathology, case histories, interictal EEG, and surgical outcome were compared. RESULTS: There was a tendency for group 1 patients to have earlier seizure onset age (10.9+/-6.35 versus 14.5+/-6.03, p=0.06) There was no statistically significant difference in the history of febrile convulsions (68.4% versus 53.8%, p>0.16) No statistically significant difference between groups were also found in disease duration, the head trauma/mental retardation history, seizure frequency, interictal EEG, and surgical outcome. CONCLUSIONS: CD in MTS appears to have an influence on seizure onset. The relationships among CD, febrile convulsion, and mesial temporal sclerosis must be more investigated.
Age of Onset ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Head ; Humans ; Malformations of Cortical Development* ; Pathology* ; Retrospective Studies ; Sclerosis* ; Seizures ; Seizures, Febrile ; Temporal Lobe*

BACKGROUND: The peripheral nerve is known to be vulnerable to electrical injury. However, the character and mechanism of electrical injury to the peripheral nerve is not well established in clinical conditions. METHODS: We retrospectively reviewed the nerve conduction study (NCS) data of patients who had high voltage electrical injury in their upper extremities. RESULTS: Among 16 extremities studied, nine had abnormal NCS findings. Nine of 12 extremities, whose input/output were distal to wrist, showed abnormal NCS findings. In contrast, all four extremities, whose input/output points were their forearm, had normal NCS findings. In the patients who had abnormal NCS findings, the distal portion experienced more severe damage than the proximal portion. CONCLUSIONS: Input/output points are important factors in the electrical injury to the peripheral nerve. Joule heating seems to be a more important mechanism of electrical peripheral nerve injury.
Burns* ; Extremities ; Forearm ; Heating ; Hot Temperature ; Humans ; Neural Conduction ; Peripheral Nerve Injuries* ; Peripheral Nerves* ; Retrospective Studies ; Upper Extremity ; Wrist

No abstract available.
Acute Kidney Injury ; Drug-Induced Liver Injury ; Panax

Background/Aims: This study aimed to investigate whether urinary angiotensinogen (UAGT) excretion was associated with elevated blood pressure in patients with chronic kidney disease (CKD) and to evaluate the relationship among blood pressure, intra-renal renin-angiotensin system (RAS) activity, and dietary sodium in patients with CKD. Methods: Participants from the Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease (KNOW-CKD) were included. Of the total cohort of 2,238 individuals with CKD, we included 1,955 participants who underwent complete 24-hour urinary sodium (24-hour UNa) analysis. They were categorized into three groups according to three tertiles of their 24-hour UNa, reflecting daily salt intake. To measure intra-renal RAS activity, the UAGT excretion was assayed with an enzyme-linked immunosorbent assay. Results: Elevated 24-hour UNa levels, logarithm of UAGT-to-creatinine ratio (UAGT/Cr), increased waist-to-hip ratio, and decreased estimated glomerular filtration rate were the risk factors for increased systolic blood pressure. Systolic blood pressure showed a positive correlation with 24-hour UNa levels and logarithm of UAGT/Cr. Conclusions UAGT and urinary sodium excretion are independent determinants of systolic blood pressure in patients with CKD. These findings suggest that increased systolic blood pressure in CKD patients is associated with both increased dietary sodium levels and intra-renal RAS activity. The risk of elevated systolic blood pressure in the 3rd tertile of both the UAGT/Cr and 24-hour UNa groups was about 2.3 times higher than that in the reference group.

Background/Aims: This study aimed to investigate whether urinary angiotensinogen (UAGT) excretion was associated with elevated blood pressure in patients with chronic kidney disease (CKD) and to evaluate the relationship among blood pressure, intra-renal renin-angiotensin system (RAS) activity, and dietary sodium in patients with CKD. Methods: Participants from the Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease (KNOW-CKD) were included. Of the total cohort of 2,238 individuals with CKD, we included 1,955 participants who underwent complete 24-hour urinary sodium (24-hour UNa) analysis. They were categorized into three groups according to three tertiles of their 24-hour UNa, reflecting daily salt intake. To measure intra-renal RAS activity, the UAGT excretion was assayed with an enzyme-linked immunosorbent assay. Results: Elevated 24-hour UNa levels, logarithm of UAGT-to-creatinine ratio (UAGT/Cr), increased waist-to-hip ratio, and decreased estimated glomerular filtration rate were the risk factors for increased systolic blood pressure. Systolic blood pressure showed a positive correlation with 24-hour UNa levels and logarithm of UAGT/Cr. Conclusions UAGT and urinary sodium excretion are independent determinants of systolic blood pressure in patients with CKD. These findings suggest that increased systolic blood pressure in CKD patients is associated with both increased dietary sodium levels and intra-renal RAS activity. The risk of elevated systolic blood pressure in the 3rd tertile of both the UAGT/Cr and 24-hour UNa groups was about 2.3 times higher than that in the reference group.