No abstract available.
Humans ; Orthognathic Surgery*

No abstract available.
Drug Therapy*

The mandibular contour determines the shape of the lower part of the face and thus influences the appearance of the face. A patient with a large, squarish, or broad face who desires a small, round, or slender face can undergo mandibular contouring surgery to reduce the width of the lower face. The successful correction of a prominent mandibular angle by conventional angle ostectomy has been reported. But, in the majority of patients with a widened facial appearance, both the mandibular angle and part of the mandibular body anterior to it are protuberant laterally, so both must be resected. The purpose of this study is to introduce a new method of performing mandibular contouring surgery, more effectively and easily, and to reduce postoperative complication and evaluate its results. We treated 6 patients who has prominent mandibular angle using multiple step osteotomy with angle-splitting ostectomy. The advantages of this new method are as following. (1) easily performable (2) effective mandibular contouring surgery by reducing the width of lower face (3) producing a natural relief of the mandibular angle (4) low risk of soft tissue damage and complications (5) shortening of the operation time. etc.
Humans ; Osteotomy ; Postoperative Complications

OBJECTIVE: Cardiovascular disease is the most frequent cause of death in rheumatoid arthritis(RA) patients and hyperhomocysteinemia is an independent risk factor for cardiovascular disease. We evaluated the status of homocysteine, vitamin B12 and folate in RA patients and the influence of the drugs used in RA on homocysteine and vitamin levels. METHODS: Fifty-six RA patients and 22 controls were studied. Plasma total homocysteine was measured by HPLC method and serum folate and vitamin B12 were measured by chemiluminescence immunoassay. In RA patients, age, sex, disease duration, medications and laboratory findings were analyzed. RESULTS: Serum vitamin B12 level was significantly lower in RA patients compared to controls(p=0.033). No significant difference in serum folate level was found between RA patients and controls but plasma total homocysteine level was significantly higher in RA patients. There was no difference in plasma total homocysteine level between patients taking MTX with folate and controls, but plasma total homocysteine level was significantly higher in patients not taking MTX compared with controls(p=0.028). In RA patients taking only hydroxychloroquine(HCQ) as a DMARD, there was significantly lower serum folate level(p=0.033) and higher plasma total homocysteine level(p=0.043) compared with controls. There was a significant negative correlation between plasma total homocysteine level and serum folate level in RA patients(r=-0.319, p=0.017). CONCLUSION: Plasma total homocysteine level was increased in RA patients but not in patients taking MTX and folate. These findings suggested that folate supplementation may be effective to prevent hyperhomocysteinemia in RA patients.
Antirheumatic Agents ; Arthritis, Rheumatoid* ; Cardiovascular Diseases ; Cause of Death ; Chromatography, High Pressure Liquid ; Folic Acid* ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Immunoassay ; Luminescence ; Plasma* ; Risk Factors ; Vitamin B 12* ; Vitamins*

PURPOSE: To assess the effectiveness of subsegmental transcatheter arterial chemoembolization(TAE) forhepatocellular carcinomas(HCCs) on the basis of tumor necrosis rate. MATERIAL AND METHODS: Between May 1996 andMarch 1998, ten patients with single HCC after subsegmental TAE underwent surgical resection. Subsegmental TAE wasperformed by injecting a mixture of lipiodol and adriamycin followed by gelatin sponge particles into the distalbranches of the subsegmental arteries. Tumor size and the extent of necrosis were analyzed in ten resectedlesions, and in all patients, complications after subsegmental TAE were assessed. RESULTS: The size of resectedtumors ranged from 1 to 5,5cm. On histological examination, complete necrosis was seen in 6 to 10 resected lesionsand 95% necrosis in three. In the remaining lesion, 85% necrosis had occured. Complete necrosis was noted in 4 of6 small HCCs(less than 3cm in diameter), while in the remaining two the extent of necrosis was 95%. Nocomplications were observed. CONCLUSION: For the treatment of HCC, subsegmental TAE is safe and effective.Curative therapy must, however, involve follow-up and repeated TAE.
Arteries ; Carcinoma, Hepatocellular* ; Doxorubicin ; Ethiodized Oil ; Follow-Up Studies ; Gelatin ; Humans ; Liver Neoplasms ; Necrosis ; Porifera

Congenital adrenal insufficiency is caused by specific genetic mutations. Early suspicion and definite diagnosis are crucial because the disease can precipitate a life-threatening hypovolemic shock without prompt treatment. This study was designed to understand the clinical manifestations including growth patterns and to find the usefulness of ACTH stimulation test. Sixteen patients with confirmed genotyping were subdivided into three groups according to the genetic study results: congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH, n=11), congenital lipoid adrenal hyperplasia (n=3) and X-linked adrenal hypoplasia congenita (n=2). Bone age advancement was prominent in patients with CAH especially after 60 months of chronologic age (n=6, 67%). They were diagnosed in older ages in group with bone age advancement (P<0.05). Comorbid conditions such as obesity, mental retardation, and central precocious puberty were also prominent in this group. In conclusion, this study showed the importance of understanding the clinical symptoms as well as genetic analysis for early diagnosis and management of congenital adrenal insufficiency. ACTH stimulation test played an important role to support the diagnosis and serum 17-hydroxyprogesterone levels were significantly elevated in all of the CAH patients. The test will be important for monitoring growth and puberty during follow up of patients with congenital adrenal insufficiency.
17-alpha-Hydroxyprogesterone/blood ; 46, XY Disorders of Sex Development/drug therapy/*genetics ; Adolescent ; Adrenal Hyperplasia, Congenital/drug therapy/*genetics ; Adrenal Insufficiency/*congenital/diagnosis/drug therapy/genetics ; Adrenocorticotropic Hormone/*metabolism ; Bone Development/genetics ; Child ; Child, Preschool ; DAX-1 Orphan Nuclear Receptor/genetics ; Female ; Genetic Diseases, X-Linked/drug therapy/*genetics ; Genotype ; Glucocorticoids/therapeutic use ; Humans ; Intellectual Disability/complications ; Male ; Mineralocorticoids/therapeutic use ; Obesity/complications ; Phosphoproteins/genetics ; Puberty, Precocious/complications ; Retrospective Studies ; Steroid 21-Hydroxylase/genetics

X-linked adrenal hypoplasia congenita is caused by the mutation of DAX-1 gene (dosage-sensitive sex reversal, adrenal hypoplasia critical region, on chromosome X, gene 1), and can occur as part of a contiguous gene deletion syndrome in association with glycerol kinase (GK) deficiency, Duchenne muscular dystrophy and X-linked interleukin-1 receptor accessory protein-like 1 (IL1RAPL1) gene deficiency. It is usually associated with hypogonadotropic hypogonadism, although in rare cases, it has been reported to occur in normal puberty or even central precocious puberty. This study addresses a case in which central precocious puberty developed in a boy with X-linked adrenal hypoplasia congenita who had complete deletion of the genes DAX-1, GK and IL1RAPL1 (Xp21 contiguous gene deletion syndrome). Initially he was admitted for the management of adrenal crisis at the age of 2 months, and managed with hydrocortisone and florinef. At 45 months of age, his each testicular volumes of 4 mL and a penile length of 5 cm were noted, with pubic hair of Tanner stage 2. His bone age was advanced and a gonadotropin-releasing hormone (GnRH) stimulation test showed a luteinizing hormone peak of 8.26 IU/L, confirming central precocious puberty. He was then treated with a GnRH agonist, as well as steroid replacement therapy. In Korea, this is the first case of central precocious puberty developed in a male patient with X-linked adrenal hypoplasia congenita.
Adrenal Hyperplasia, Congenital ; Adrenal Insufficiency ; DAX-1 Orphan Nuclear Receptor ; Fludrocortisone ; Gene Deletion ; Genetic Diseases, X-Linked ; Glycerol Kinase ; Gonadotropin-Releasing Hormone ; Hair ; Humans ; Hydrocortisone ; Hypogonadism ; Interleukin-1 ; Korea ; Luteinizing Hormone ; Male ; Muscular Dystrophy, Duchenne ; Puberty ; Puberty, Precocious

X-linked adrenal hypoplasia congenita is caused by the mutation of DAX-1 gene (dosage-sensitive sex reversal, adrenal hypoplasia critical region, on chromosome X, gene 1), and can occur as part of a contiguous gene deletion syndrome in association with glycerol kinase (GK) deficiency, Duchenne muscular dystrophy and X-linked interleukin-1 receptor accessory protein-like 1 (IL1RAPL1) gene deficiency. It is usually associated with hypogonadotropic hypogonadism, although in rare cases, it has been reported to occur in normal puberty or even central precocious puberty. This study addresses a case in which central precocious puberty developed in a boy with X-linked adrenal hypoplasia congenita who had complete deletion of the genes DAX-1, GK and IL1RAPL1 (Xp21 contiguous gene deletion syndrome). Initially he was admitted for the management of adrenal crisis at the age of 2 months, and managed with hydrocortisone and florinef. At 45 months of age, his each testicular volumes of 4 mL and a penile length of 5 cm were noted, with pubic hair of Tanner stage 2. His bone age was advanced and a gonadotropin-releasing hormone (GnRH) stimulation test showed a luteinizing hormone peak of 8.26 IU/L, confirming central precocious puberty. He was then treated with a GnRH agonist, as well as steroid replacement therapy. In Korea, this is the first case of central precocious puberty developed in a male patient with X-linked adrenal hypoplasia congenita.
Adrenal Hyperplasia, Congenital ; Adrenal Insufficiency ; DAX-1 Orphan Nuclear Receptor ; Fludrocortisone ; Gene Deletion ; Genetic Diseases, X-Linked ; Glycerol Kinase ; Gonadotropin-Releasing Hormone ; Hair ; Humans ; Hydrocortisone ; Hypogonadism ; Interleukin-1 ; Korea ; Luteinizing Hormone ; Male ; Muscular Dystrophy, Duchenne ; Puberty ; Puberty, Precocious

We report here a case of strongyloidiasis in a 72-year-old diabetic patient (woman) accompanied by gastrointestinal stromal tumor receiving imatinib therapy, first diagnosed as hypereosinophilic syndrome and treated with steroids for uncontrolled eosinophilia. She suffered from lower back pain and intermittent abdominal discomfort with nausea and diagnosed with gastrointestinal stromal tumor. After post-operative imatinib treatment eosinophilia persisted, so that steroid therapy was started under an impression of hypereosinophilic syndrome. In spite of 6 months steroid therapy, eosinophilia persisted. Stool examination was performed to rule out intestinal helminth infections. Rhabditoid larvae of Strongyloides stercoralis were detected and the patient was diagnosed as strongyloidiasis. This diagnosis was confirmed again by PCR. The patient was treated with albendazole for 14 days and her abdominal pain and diarrhea improved. This case highlights the need for thorough investigation, including molecular approaches, to test for strongyloidiasis before and during steroid therapies.
Aged ; Albendazole/administration & dosage ; Animals ; Diabetes Mellitus, Type 2/complications ; Eosinophilia/complications/*drug therapy ; Female ; Gastrointestinal Stromal Tumors/complications/*drug therapy ; Humans ; Imatinib Mesylate/*administration & dosage ; Steroids/*administration & dosage ; Strongyloides stercoralis/genetics/isolation & purification/physiology ; Strongyloidiasis/*drug therapy/parasitology

OBJECTIVE: The positive rates of hepatitis B virus (HBV) markers differ according to age, sex, race, locality, sexual behavior, socioeconomic conditions, immunologic and genetic factors. It is a well-known fact that Korea is one of the endemic areas of HBV infection in the world. Past many reports have presented that the positive rates of HBsAg and anti-HBs in Korea were about 6~14% and 30~62%, respectively. However there were a few epidemiological surveys of rural communities on the positive rates of HBV markers. The present study undertook to determine the positive rates of HBsAg and anti-HBs in Hwasun county, a rural area of Korea. METHODS: We performed Population-based cross- sectional study by random cluster sampling of registered residents in Hwasun county. Out of the 2,920 subjects (4.1%) scheduled for the survey, 1,913 residents underwent the actual examination. We tested HBsAg and anti- HBs by reversed passive hemagglutination (RPHA) and passive hemagglutination (PHA), respectively. RESULTS: The positive rates of HBsAg and anti-HBs in all subjects were 5.6% and 20.8%, respectively, and those were 5.4% and 20.4% in 168 pregnant women, respectively. The positive rate of HBsAg was significantly higher in male (8.2%) than in female (4.0%) (p< 0.01). The positive rate of anti-HBs was 21.4% in female, but it was not significanly higher than in male (19.6%). There were no significant differences according to age groups in the positive rates of HBsAg and anti-HBs. CONCLUSION: There are no significant changes in the positive rates of HBsAg and anti-HBs between the present study for Hwasun county and past many reports in Korea. Although the rate of hepatitis B vaccination increased significantly, it was not effective because that the vaccinated total numbers in the rural area of Korea were probably small. So it is very important to undertake a nationwide program of hepatitis B immunization and to educate the residents in rural areas of Korea.
Continental Population Groups ; Female ; Hemagglutination ; Hepatitis B ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Humans ; Immunization ; Korea* ; Male ; Pregnant Women ; Rural Population ; Sexual Behavior ; Vaccination