Commonly, the lateral canthus is located higher than medial canthus and many people are often shown short lateral palpebral fissure. This seemed to be shown as wild, anxious, and pierced eye. Many surgeons have made desperate efforts to improve this by anchoring lateral canthus to lower part of orbital bone. But, authors would like to show the two-third portion of the lateral lower eyelid by anchoring to capsulopalpebral fascia via transconjunctival approach. Authors performed this operation since 2009 and first named it by "Nun-Mit-Teuim" in Korean. Key of this operation is that anchoring of the lower tarsus and capsulopalpebral fascia via transconjunctival approach without resection of skin. It is not necessary to remove a redundant conjunctiva. Commonly, the lateral canthoplasty is performed simultaneously to descend a lower eyelid easily. After the operation, it can be observed that the lower eyelid lift up a little bit for 1~2 weeks and redundant conjunctiva will be constricted in several months. The operation is defined as anchoring the lower tarsus to capsulopalpebral fascia. The limit of the operation is it cannot change the position of the lateral canthus. Over-lowering the lower eyelid to increase palpebral fissure, results in scleral show and unfavorable line. Thus, it is important that surgeons should remind the purpose and limitation of this operation.
Animals ; Ankle ; Conjunctiva ; Eye ; Eyelids ; Fascia ; Isothiocyanates ; Orbit ; Skin

A giant cell tumor of bone is a benign bone tumor, but has very high local recurrence rate and, very rarely metastasizes to the lung or a distant area. We report a case of a 29-year-old male patient presenting with a metastatic giant cell tumor of the soft tissue of the chest wall, who underwent a total resection of the radius for recurrence of the giant cell tumor. The tumor was not related to any bony structure of the thorax. We resected the tumor with a wide surgical margin. No evidence of malignancy was seen in the frozen and permanent pathological report.
Adult ; Giant Cell Tumor of Bone ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Lung ; Male ; Radius ; Recurrence ; Thoracic Wall* ; Thorax

The incidence of intracranal aneurysm is rare in childhood and adolescence. During the period from January 1982 through December 1989, 793 aneurysms were operated on the our department. Of these 8 aneurysms occurred 8 patients under age of 18 years. The average age was 11.6 years(range 4 to 18 years). There were 6 male and 2 females. Presenting sings and symptoms included SAH in 6 aneurysms and focal neurologic deficits in 2 aneurysms. All aneurysms were surgically treated : direct clipping was performed in 6, aneurysmorraphy in 1, trapping alone in 1. The postoperative result were excellent in 5, good in 2, and fair in 1. The rarity of such lesions in childhood and adolescence and their pathogenesis are reviewed briefly.
Adolescent* ; Aneurysm ; Female ; Humans ; Incidence ; Intracranial Aneurysm* ; Male ; Neurologic Manifestations

The authors are reporting traumatic giant aneurysm arising from supraclinoid portion of internal carotid artery. The patients was a 22-years old man who had suffered a major head injury in a traffic accident. On admission he was comatous and there were multiple abrasion over the body and severe hemorrhage comming from the left ear with open fracture in left parietal. 4 weeks later, computed tomographic scan demonstrated large well enhanced mass in the suprasellar region. Carotid angiography showed giant aneurysm fed by supraclinoid portion of internal carotid artery. After frontotemporal craniectomy, direct approach was performed using surgical microscope.
Accidents, Traffic ; Aneurysm* ; Angiography ; Carotid Artery, Internal ; Craniocerebral Trauma ; Ear ; Fractures, Open ; Hemorrhage ; Humans ; Rabeprazole ; Young Adult

BACKGROUND: Deep Hypothermic circulatory Arrest (DHCA) is widely used during heart surgery in neonates and infants and complicated surgeries in adults such as a pulmonary thromboendarterectomy (PTE). However safe limits of time and temperature during DHCA still remain controversial. Futhermore it's effects on neurologic outcome has been controversial. METHODS: On the postoperative 3 days, we examined the neurologic function of 12 patients who received a PTE. During the PTE, DHCA was done 2 or 3 times within 20 minutes. Between DHCAs the patients were perfused at a low flow rate with 18degreesC blood until their venous saturation returned to 90%. Neurologic evaluations included level of consciousness, Glasgow coma scale (GCS), and motor and sensory functions. RESULTS: Neurologic functions of all of the patients assessed on the 3 days postoperatively was grossly normal. All 12 patients were oriented to time, place, and person with normal gross motor and sensory functions. CONCLUSIONS: No significant neurologic complications were related to the technique of two or three times of short DHCA within 20 minutes, for a total not exceeding 60 minutes.
Adult* ; Brain* ; Circulatory Arrest, Deep Hypothermia Induced* ; Consciousness ; Endarterectomy ; Glasgow Coma Scale ; Humans ; Infant ; Infant, Newborn ; Sensation ; Thoracic Surgery

PURPOSE: It is controversial to treat complicated appendicitis in pediatric patients on several points, especially optimal time for appendectomy. The purpose of this study is to determine optimal time for operation in perforated appendicitis in pediatric patients. METHODS: Children with perforated appendicitis under the age of 14 underwent appendectomy between January 2006 and December 2008 at Ewha Womans University Mokdong Hospital were analyzed retrospectively according to factors which may affect the postoperative hospital course such as complications, time of beginning of diet, and length of hospital stay. RESULTS: During the study period, 357 patients with acute appendicitis underwent appendectomy and 118 patients were diagnosed with perforated appendicitis. Comparing symptom durations between more than 48 hours and less, the former induced significantly higher postoperative complication rates. Body temperature above 37.5degrees C at admission affected significantly higher complication rates and delay of beginning of diet. Children with intraabdominal abscess at appendectomy showed higher complication rates than without abscess. Children who underwent operation in the daytime started diet significantly earlier and showed less complication than those operated on at night. The frequency of preoperative antibiotics administration did not alter the postoperative hospital course. CONCLUSION: For the children diagnosed with perforated appendicitis, non-urgent appendectomy in the daytime after initial conservative management including intravenous administration of antibiotics, hydration, and correction of serum electrolyte is safer and more efficient than performing emergency operation, and moreover there is no necessity for secondary admission for interval appendectomy.
Abscess ; Administration, Intravenous ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Body Temperature ; Child ; Diet ; Emergencies ; Female ; Humans ; Postoperative Complications ; Retrospective Studies

The reconstruction after radical vulvectomy presents a difficult challenge. Ideal flap for vulvoperineal reconstruction has thin character, constant vascular supply, and presents concealed scar after reconstruction. Various flaps are used for reconstruction of the vulvar area, have their own advantages and disadvantages. The authors performed 15 vulvoperineal reconstructions using three kinds of different 28 fasciocutaneous flaps. Gluteal fold fasciocutaneous island flap seems like labia major and remains concealed donor scar along the gluteal fold. But secondary debulking procedure is sometimes required. Vulvoperineal V-Y advancement fasciocutaneous flap is thin, reliable, easily elevated, and matches with regional skin quality, but donor site scar is conspicuous on medial thigh. Gluteal fold V-Y advancement fasciocutaneous flap is also reliable, easily elevated, and matches with regional skin quality with thin flap and concealed donor scar on gluteal fold. Also, it can be advanced even a long distance. Through our experiences, these flaps are very useful for vulvar reconstruction, but in the aspect of donor site scar, thickness, and degree of advancement, gluteal fold V-Y advancement fasciocutaneous flap is superior to the other two patterns for the reconstruction of the large sized vulvoperineal defect.
Cicatrix ; Humans ; Skin ; Thigh ; Tissue Donors

OBJECTIVE: To report an observational investigation of small high attenuated foci in computed tomography (CT) scan followed by brain parenchymal catheterization. METHODS: From January 2011 to March 2015, we retrospectively reviewed the 381 patients who had undergone brain catheterization in our clinic and enrolled the patients who had newly developed high attenuation foci in the postoperative CT scans. The brain CT scans were reviewed about the lesion location, Hounsfield Unit (HU) and the time of appearance. RESULTS: Twenty seven of 381 patients had high attenuation foci in CT scans after the procedure. The location of high density lesions was as follows: parenchyma in 9 (33.3%) cases, ventricle in 5 (18.5%), combined in parenchyma and ventricle in 13 (48.1%). The lesions were identified in the catheter tract in parenchymal type, and catheter-lodged frontal horn or choroid plexus in ventricular type. We could not find the calcific foci before the catheter removal, and those were found after removal in all cases. The time of appearance after the removal was variable from 0 to 14 days (mean 4.2, median 3). The regular rules of HU change in CT scans were not found as times go on. CONCLUSION: The high attenuation foci in CT scans were bone dust originated from skull during operation. Although these lesions did not make troubles, we should clean the operation field before the insertion of brain catheter and we may use another material, like Surgicel to seal up the burr hole instead of bone dust in the end of operation.
Animals ; Bone Transplantation ; Brain* ; Calcinosis ; Catheterization* ; Catheters* ; Choroid Plexus ; Dust ; Horns ; Humans ; Retrospective Studies ; Skull ; Tomography, X-Ray Computed

STATEMENT OF PROBLEM: In order to increase preload with reducing the friction coefficient, abutment screws coated with pure gold and Teflon as dry lubricant coatings have been introduced. But the reported data indicate that if screw repeated tightening and loosening cycle, an efficiency of increasing preload was decreased by screw surface wearing off. PURPOSE: This study was to evaluate the influence of tungsten carbide/carbon coating, which has superior hardness and frictional wear resistance, on the preload of abutment screws and the stability of coating surface after repeated closures. MATERIAL AND METHOD: The rotational values of abutment screws and the compressive forces between abutment and fixture were measured in implant systems with three different joint connections, one external butt joint and two internal cones. Moreover, the stability and the alteration of coating surface were examined by comparison of the compressive force and the removable torque values during 10 consecutive trials, observation with scanning electron microscope and analyzed the elemental composition with energy dispersive x-ray spectroscopy. RESULTS AND CONCLUSION: 1. Application of coating resulted in significant increase of compressive force in all implant systems(P<.05). The increasing rate of compressive force by coating in external butt joint was greater than those in internal cones(P<.05). 2. Coated screw showed the significant additional rotation compared to non-coated screw in all implant systems(P<.05). There were no significant differences in the increasing rate of rotation among implant systems(P>.05). 3. Removable torque values were greater with non-coated screw than that with coated screw (P<.05). 4. Coated screw showed insignificant variations in the compressive forces during 10 consecutive trials(P>.05). 5. After repeated trials, the surface layer of coated screw was maintained relatively well. However, surface wearing and irregular titanium fragments were found in non-coated screw.
Friction ; Hardness ; Joints ; Polytetrafluoroethylene ; Spectrometry, X-Ray Emission ; Titanium ; Torque ; Tungsten*

BACKGROUND: Heavily transfused patients commonly become refractory to platelet transfusion. Patients with platelet refractoriness due to HLA alloimmunization need HLA-matched platelet transfusion. We have established an hospital-based donor registry of HLA-typed platelet donors for the first time in Korea and evaluated the possibility of HLA-matched platelet supplies. METHODS: A total of 450 donors were registered and typed for HLA class I (A, B, C) antigens. A computer program was developed and used for the donor registry and HLA-matched donor search. A simulation study was performed on the availability of HLA-matched platelets for 100 patients from a pool of 450 donors. The availability of HLA-matched and cross reactive epitope group (CREG)-matched donors were analysed for HLA-A, B antigens. The CREGs defined by Fuller, Rodey, and UCLA criteria were used. RESLUTS: Among 100 patients, 63% had HLA-identical or HLA-matched (match grade: A, B1U, B2U) donors with only a low number of donors (mean 1.4) available per patient. Including CREG-matches (match grade: B1X, B2UX, B2X), majority (98%) of the patients had HLA- or CREG-matched (match grade: A~B2X) platelet donors with a higher number of donors (mean 26.6~40.5 by different CREG criteria) available per patient. Majority (86-98%) of the patients had 20 or more A~B4X matched donors, and about two thirds (61-74%) of the patients had 20 or more A~B2X matched donors. However, the number of ABO-identical matched donors was less than 30% of the total HLA- or CREG-matched donors. CONCLUSION: We established an HLA-matched platelet donor registry and using a donor pool size of < 500 donors, attainable in an hospital-based donor registry, the possibility of HLA-matched platelet supplies was confirmed in this study. However, for more satisfactory and ABO-matched platelet supplies a larger pool size is needed.
Blood Platelets* ; Equipment and Supplies ; HLA-A Antigens ; Humans ; Korea ; Platelet Transfusion ; Tissue Donors*