Nasal valve dysfunction can substantially impact nasal airflow and overall quality of life. This review provides a comprehensive examination of nasal valve dysfunction, including its mechanisms, classification, and surgical management. The nasal valves include internal and external valves, each of which plays a crucial role in regulating nasal airflow. Subclassification of the external nasal valve into alar and rim valves helps specify the site of obstruction when present and informs the choice of surgical intervention. Dynamic nasal valve obstruction, often characterized by inspiratory collapse of the nasal valve, must be distinguished from static obstruction, which refers to nasal valve stenosis. Accurate identification of the location and mechanism of nasal valve dysfunction is essential for effective management. Various surgical procedures target specific components of the nasal valve and can produce favorable functional outcomes. The selection of surgical procedures, whether individually or in combination, should be tailored to the characteristics of nasal valve dysfunction and the external nasal characteristics of the patient. Strict adherence to proper surgical techniques is imperative for achieving optimal treatment outcomes.

BACKGROUND: The effects of dexmedetomidine on the propofol-sparing effect and intraoperative hemodynamics during remifentanil-based propofol-supplemented anesthesia have not been well investigated. METHODS: Twenty patients undergoing breast surgery were randomly allocated to receive dexmedetomidine (group DEX) or placebo (group C). In the DEX group, dexmedetomidine was loaded (1 microg/kg) before anesthesia induction and was infused (0.6 microg/kg/h) during surgery. Anesthesia was induced with a target-controlled infusion (TCI) of propofol (effect site concentration, Ce; 3 microg/ml) and remifentanil (plasma concentration, Cp, 10 ng/ml). The Ce of TCI-propofol was adjusted to a bispectral index of 45-55, and Cp of TCI-remifentanil was fixed at 10 ng/ml in both groups. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at baseline (T-control), after the loading of study drugs (T-loading), 3 min after anesthesia induction (T-induction), tracheal intubation (T-trachea), incision (T-incision), 30 min after incision (T-incision30), and at tracheal extubation (T-extubation). MAP% and HR% (MAP and HR vs. T-control) were determined and the propofol infusion rate was calculated. RESULTS: The propofol infusion rate was significantly lower in the DEX group than in group C (63.9 +/- 16.2 vs. 96.4 +/- 10.0 microg/kg/min, respectively; P < 0.001). The changes in MAP% at T-induction, T-trachea and T-incision in group DEX (-10.0 +/- 3.9%, -9.4 +/- 4.6% and -11.2 +/- 6.3%, respectively) were significantly less than those in group C (-27.6 +/- 13.9%, -21.7 +/- 17.1%, and -25.1 +/- 14.1%; P < 0.05, respectively). CONCLUSIONS: Dexmedetomidine reduced the propofol requirement for remifentanil-based anesthesia while producing more stable intraoperative hemodynamics.
Airway Extubation ; Anesthesia ; Arterial Pressure ; Breast ; Dexmedetomidine ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Piperidines ; Propofol

PURPOSE: To prepare for vaccine shortages under an influenza pandemic, several antigen-sparing strategies have been investigated. This study was aimed to evaluate the immunogenicity of influenza vaccine at reduced intradermal and full intramuscular dose. MATERIALS AND METHODS: We compared the effect of one-fifth and one-half intradermal doses to the full intramuscular dose on immunogenicity in healthy young adults, using a commercial influenza vaccine. A hemagglutination inhibition assay was used to compare the immunogenicity of the vaccination methods. RESULTS: The one-fifth intradermal dose (3 microg hemagglutinin antigen, HA) was given to 30 participants, the one-half intradermal dose (7.5 microg HA) was given to 30, and the full intramuscular dose (15 microg HA) was given to 32. No significant differences among injection routes and dosages were seen for seroprotection rate, seroconversion rate, or geometric mean titer (GMT) fold-increase for A/H1N1, A/H3N2, and B at around 4 weeks from vaccination. Although GMT for influenza B was significantly lower at six months for the one-fifth intradermal vaccination compared to the full-dose intramuscular vaccination (32.8 vs. 63.2, p=0.048), all three groups met the Evaluation of Medicinal Products (EMA) immunogenicity criteria through 1 to 6 months. CONCLUSION: Intradermal administration of a one-fifth dose of influenza vaccine elicited antibody responses comparable to the intradermal one-half dose and a conventional intramuscular vaccination at 1 month post-vaccination. The immunogenicity of the one-fifth intradermal dose was sufficient to meet the requirement for the EMA criteria at six months after influenza vaccination.
Adult ; Antibody Formation ; Hemagglutination ; Hemagglutinins ; Humans ; Influenza Vaccines ; Influenza, Human ; Injections, Intradermal ; Pandemics ; Vaccination ; Vaccines ; Young Adult

PURPOSE: To investigate the prevalence of ADHD (attention-deficit hyperactivity disorder) in children with epilepsy and to determine the difference of characteristics in patients with epilepsy and concomitant ADHD as opposed to the patients without ADHD for better management. METHODS: We retrospectively reviewed 184 patients diagnosed as epilepsy and treated with antiepileptic drugs in pediatric neurology department of Seoul St. Mary's hospital from March, 2009 to May, 2012. Their ages ranged from 6 to 18 years. The subjects were included in the study those who made a regular visit for more than a year. RESULTS: 1) Out of 184 patients, 69 patients (37.5%) had both ADHD and epilepsy. 2) In epilepsy children with ADHD, male outnumbered female by almost two fold (male 67: female 33) (P=0.022). 3) In epilepsy children with ADHD, epileptiform discharges on EEG was focused in central regions in 39% of them (P=0.014). 4) In 56% of patients without ADHD, their seizures remained under the control with single anticonvulsant, as opposed to 36% of patients with both ADHD and epilepsy (P=0.001). Therefore, the presence of ADHD in patients with epilepsy might be related to the therapeutic response to anticonvulsants, and be a useful predictive factor for the response to early treatment. CONCLUSION: Patients with epilepsy and concomitant ADHD showed a significant difference and poor response to epilepsy treatment, as opposed to patients without ADHD. Therefore, early detection and establishment of countermeasures for ADHD is necessary.
Anticonvulsants ; Child* ; Electroencephalography ; Epilepsy* ; Female ; Humans ; Male ; Neurology ; Prevalence ; Retrospective Studies ; Seizures ; Seoul

Degos disease, also referred to as malignant atrophic papulosis, was first described in 1941 by Köhlmeier and was independently described by Degos in 1942. Degos disease is characterized by diffuse, papular skin eruptions with porcelain-white centers and slightly raised erythematous telangiectatic rims associated with bowel infarction. Although the etiology of Degos disease is unknown, autoimmune diseases, coagulation disorders, and vasculitis have all been considered as underlying pathogenic mechanisms. Approximately 15% of Degos disease have a benign course limited to the skin and no history of gastrointestinal or central nervous system (CNS) involvement. A 29-year-old female with history of systemic lupus erythematosus (SLE) presented with a 2-year history of asymptomatic lesions on the dorsum of all fingers and both knees. The patient had only skin lesions and no gastrointestinal or CNS vasculitis symptoms. Her skin lesions were umbilicated, atrophic porcelain-white lesions with a rim of erythema. On the basis of clinical, histologic, and laboratory findings, a diagnosis of Degos-like lesions associated with SLE was made. The patient had been treated for SLE for 7 years. Her treatment regimen was maintained over a 2 month follow-up period, and the skin lesions improved slightly with no development of new lesions.
Adult ; Autoimmune Diseases ; Central Nervous System ; Diagnosis ; Erythema ; Female ; Fingers ; Follow-Up Studies ; Humans ; Infarction ; Knee ; Lupus Erythematosus, Systemic* ; Malignant Atrophic Papulosis ; Skin ; Vasculitis ; Vasculitis, Central Nervous System

PURPOSE: Split thickness skin graft (STSG) is frequently used for reconstructing wounds. The treatment of split-thickness donor sites demands several factors: maintenance a moist condition, minimization of pain, promotion of re-epithelization and ease of care. We have performed a study to evaluate efficacy of Physiotulle® for donor site management. METHODS: A prospective study was conducted from June 2015 to December 2015 and included 20 patients undergoing surgery for reconstructive purposes with the use of STSG. The grafts harvested with a same manner and the donor sites were managed with one of the two dressing material: Physiotulle® or Bactigras®. We campared post-operative pain scale, bleeding of donor site, period of re-epithelization and donor site infection. RESULTS: All of 20 patients were well healed after application of Physiotulle® or Bactigras® dressing without any complications. Pain level was similar between two groups until 3 days after operation but Physiotulle® (4.1±0.233) showed significant (P<0.01) pain increasing on 7 days after operation compared with Bactigras® (2.9±0.277). The bleeding index score on 7 days after operation of Physiotulle® (2.5±0.167) was higher than Bactigras® (2.0±0.211) but there is no difference. Statistically (**P<0.01), the period of re-eopithelization of Physiotulle® (13.50±0.87) was significantly shorten than Bactigras® (17.25±0.65). CONCLUSION: Physiotulle® is effective in re-epithelization. We recommend applying ointment on donor site when exudate is minimized, about 7 days after operation to prevent aggravation of pain and bleeing of donor site.
Bandages ; Exudates and Transudates ; Hemorrhage ; Humans ; Prospective Studies ; Skin* ; Tissue Donors* ; Transplants* ; Wound Healing* ; Wounds and Injuries*

PURPOSE: The purpose of management of split thickness skin graft (STSG) donor site is to promote healing process and minimize pain and infection. There are many dressing materials for managing donor site. The study aimed to compare the effect on management of donor site between Biatain Ibu® (polyurethane foam with incorporated ibuprofen) and Mepilex® (polyurethane foam coated with silicone). Especially, we focused on manage of donor site pain and treatment satisfaction. METHODS: This prospective study was conducted on 30 patients underwent STSG from January 2015 to June 2015. The grafts harvested with a same manner and the donor sites were managed with Biatain Ibu® or Mepilex®. Donor site pain, treatment satisfaction, days for re-epithelization and complication were compared between the two groups. RESULTS: All of 30 patients were well healed and there was no complications. Pain level of Biatain Ibu® (2.32±0.929) was lower than Mepilex® (4.77±1.224). Treatment satisfaction of Biatain Ibu® (8.40±0.632) was higher than Mepilex® (7.33±0.487). There is no statistically differences (P=0.455) in the days for re-eopithelization between Biatain Ibu® (14.73±0.789) and Mepilex® (14.53±0.639). CONCLUSION: The Biatain Ibu® dressing represents a valuable alternative in the management of STSG donor site by providing an appropriate wound healing, reduction of pain and improving treatment satisfaction.
Bandages* ; Humans ; Ibuprofen* ; Prospective Studies ; Skin* ; Tissue Donors* ; Transplants* ; Wound Healing ; Wounds and Injuries*

PURPOSE: With the advances of knowledge in wound healing process and technology in various fields, dressing material of the split thickness skin graft (STSG) donor site was improved. Recently, biologic dressing materials attracted attention and these are used for wound management. The aim of the study was to compare the efficacy of Xe-derma® (porcine acellular dermal matrix) with Kaloderm® (cultured epithelial autografts) for treatment of the donor site. METHODS: From July 2015 to January 2016, 20 patients who had undergone STSG were enrolled. The grafts harvested with a same manner and the donor sites were managed with Xe-derma® or Kaloderm®. We compared days for re-epithelization, number of dressings, ease of application, ease of wound monitoring, pain level and complications. RESULTS: All patients managed by these dressing materials were well healed without any complications. There is no statistically difference (P=0.830) between the days for re-epithelization of Xe-derma® (11.10±0.944) and Kaloderm® (11.00±1.054). Number of dressings of Xe-derma® (1.2±0.421) was lower than Kaloderm® (2.3±0.483). Ease of application of Kaloderm® (7.40±0.516) was easier than Xe-derma® (6.36±0.343). Ease of wound monitoring of Xe-derma® (7.77±0.856) was easier than Kaloderm® (6.25±0.720). Xe-derma® was more painless in 1 day and 3 days after operation than Kaloderm®. CONCLUSION: Advantageous properties of Xe-derma® are improving wound healing, reducing pain by contact to the wound immediately after application and easy of wound monitoring due to its transparency. Therefore, we expected Xe-derma® can be used for management of various wound.
Bandages ; Biological Dressings* ; Humans ; Skin* ; Tissue Donors* ; Transplants* ; Wound Healing ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effect of pulmonary valve replacement (PVR) on exercise capacity and determine cardiopulmonary exercise (CPEX) parameters associated with improvement in right ventricle (RV) function. SUBJECTS AND METHODS: We retrospectively analyzed CPEX and magnetic resonance imaging parameters in a total of 245 patients who underwent PVR from January 1998 to October 2015. In addition, we analyzed the characteristics of the patients who showed improved exercise capacity after PVR. RESULTS: Twenty-eight patients met the inclusion criteria for the study. CPEX parameters after PVR showed no significant changes in all patients. However, baseline predicted peak oxygen uptake (VO2(peak)) (%) value was significantly lower in patients with significant improvement in exercise capacity after PVR, as compared to patients who showed decreased exercise capacity after PVR (60.83±10.28 vs. 75.81±13.83) (p=0.003). In addition, patients with improved exercise capacity showed a positive correlation between the change of right ventricular ejection fraction (RVEF) (%) and the change of anaerobic threshold (r=0.733, p=0.007); whereas, patients with decreased exercise capacity showed a negative correlation between the change of RVEF (%) and the change of predicted VO2(peak) (%) (r=−0.575, p=0.020). CONCLUSION: The importance of predicted VO2(peak) (%) in evaluating exercise capacity differentiated from other CPEX variables. The change of anaerobic threshold and predicted VO2(peak) (%) might be a useful predictor of the change in RV function after PVR.
Anaerobic Threshold ; Exercise Test ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Oxygen ; Pulmonary Valve* ; Retrospective Studies ; Stroke Volume ; Tetralogy of Fallot*

Patients with advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) have an extremely poor prognosis. Although the Barcelona Clinic Liver Cancer guideline recommends sorafenib in advanced HCC with PVT, which has provided survival benefits of 2 or 3 months compared to the placebo group, many liver cancer centers in Asia still select multimodality approaches including transarterial chemoembolization, radiofrequency ablation, radiation therapy (RT) as well as systemic/intra-arterial chemotherapy. Recently advanced RT technologies have shown potential to improve survival without severe radiation-related toxicity. For locally advanced HCC patients with PVT, concurrent chemoradiotherapy (CCRT) has been applied as a loco-regional treatment and provides potential cures. We herein report our recent experience of a patient accompanying large HCC with PVT who successfully undergone CCRT followed by hepatic arterial infusion chemotherapy.
Asia ; Carcinoma, Hepatocellular* ; Catheter Ablation ; Chemoradiotherapy ; Drug Therapy ; Humans ; Liver Neoplasms ; Portal Vein* ; Prognosis ; Venous Thrombosis*