Augmentation rhinoplasty is one of the most popular aesthetic procedures in Asians. Numerous alloplastic implants have been used, however alloplastic implants may cause many problems in nasal and perinasal areas because of thin soft tissue cover. For these reasons, an ideal implant should be nonpalpable, readily exchangeable and biocompatible. Among these alloplastic implants, Gore-Tex(R) is a polymer of carbon bound to fluorine composed of solid nodes connected by very fine fibers. It has been reported that this material become permeated and surrounded by mature connective tissue, forming a strong supporting envelop for the material, yet the implant is easily removed because of limited tissue ingrowth. Since it's development, Gore-Tex(R) has found many applications in the field of facial plastic and reconstructive surgery. From November, 2001 to December, 2002, Gore-Tex(R) implants were removed from 17 patients due to several problems such as; decreased dorsal height, tip deformity, chronic inflammation. The implants were very hard to remove and coinciding injury of the surrounding tissue were inevitable. An analysis of the length and thickness changes in these removed implants was made. The results showed, decrease in length and thickness with a volume loss averaging, 46.3% in 45x4.0mm implants, 49.3% in 50x5.0mm implants. In view of the experiences of 17 cases of Gore-Tex(R) implants in rhinoplasty, we have concluded that Gore-Tex(R) implants were structurally unstable, fibrovascular tissue ingrowth into pores were minimal, the implants were very hard to remove and the implants caused a postoperative volume reduction. Therefore, Gore-Tex(R) use in augmentation rhinoplasty should be approached with caution.
Asian Continental Ancestry Group ; Carbon ; Congenital Abnormalities ; Connective Tissue ; Fluorine ; Humans ; Inflammation ; Plastics ; Polymers ; Polytetrafluoroethylene* ; Rhinoplasty*

PURPOSE: Various kinds of local flap or free flap have been used for coverage for soft tissue defects with bone exposure over the ankle and dorsum of foot. Adipofascial flaps, nourished by vascular plexuses of the subcutaneous tissue and deep fascia originating from the local perforators of the major vessels, appear particularly to be indicated for the reconstruction of these areas. Our experience with this flap on the dorsum of foot and ankle has also been quite encouraging. METHODS: The design of the flap is determined by the size and the location of the defect. The base of the flap is chosen depending on the availability of the soft tissue around the defect. The ratio of the area of the flap to the area of the base wound be more reliable to predict the survival of the turnover flap by the conventional length-to-width ratio. Nineteen patients with defect over the dorsum of the foot and ankle were resurfaced with adipofascial turn-over flaps and skin graft. RESULTS: The average age of the patients was 38.2 years(3-81 years). The flap size was from 2x3cm to 8x5cm. The average follow-up time was 6 months. All flaps survived completely except one case who suffered distal necrosis of the flap. The additional skin graft was required for partial skin loss in the five cases. Other functional impairment was not noted. CONCLUSION: Dissection of the local adipofascial turnover flap is quite easy, quick, requires less time and sacrifice of surrounding muscle itself, and maintains major arteries. In most cases, donor-site morbidity is minimal with an acceptable scar, and both functional and esthetical results were satisfactory. Therefore, Adipofascial flap could be an option for the difficult wounds around the foot and ankle.
Ankle* ; Arteries ; Cicatrix ; Fascia ; Follow-Up Studies ; Foot* ; Free Tissue Flaps ; Humans ; Necrosis ; Skin ; Subcutaneous Tissue ; Transplants ; Wounds and Injuries

PURPOSE: The current live attenuated rabies vaccine must be replaced with a safer vaccine based on the ERAGS strain to prevent rabies in South Korea. We evaluated the safety and immunogenicity of a new strain in dogs and cattle. MATERIALS AND METHODS: The ERAGS strain, featuring two mutations altering two amino acids in a glycoprotein of rabies virus, was propagated in NG108-15 cells. We lyophilized the virus in the presence of two different stabilizers to evaluate the utilities of such preparations as novel rabies vaccines for animals. To explore safety and immunogenicity, dogs and cattle were inoculated with the vaccine at various doses via different routes and observed daily for 8 weeks post-inoculation (WPI). Immunogenicity was evaluated using a fluorescent antibody virus neutralization test or enzyme-linked immunosorbent assay. RESULTS: The two different stabilizers did not differ greatly in terms of maintenance of virus viability in accelerated stability testing. No clinical signs of rabies developed in dogs or cattle inoculated with the vaccines (10(7.0) FAID₅₀/mL). Dogs and cattle inoculated intramuscularly with 10(5.0) FAID₅₀/mL exhibited virus neutralization assay titers of 4.6 IU/mL and 1.5 to 0.87 IU/mL at 4 WPI, respectively. All control animals remained rabies virus–seronegative throughout, confirming that no contact transmission occurred between vaccinated and control animals. CONCLUSION: Our findings indicate that the new rabies vaccine is safe and immunogenic in dogs and cattle.
Amino Acids ; Animals ; Cattle* ; Dogs* ; Enzyme-Linked Immunosorbent Assay ; Glycoproteins ; Korea ; Microbial Viability ; Neutralization Tests ; Rabies Vaccines* ; Rabies virus ; Rabies* ; Vaccines

Angioleiomyoma is a benign solitary tumor that arises from the medial layer of the vein walls. We encountered a 21-year-old man who was presented with a non-tender, slowly growing, 3 cm x 5 cm-sized mass on the thenar eminence of his left hand. Histopathological examination showed the tumor to be a giant vascular leiomyoma. It is extremely rare for an angioleiomyoma to reach this size as well as occurring on the palm and this is the first report of such a case in Korea.
Angiomyoma* ; Hand* ; Humans ; Korea ; Veins ; Young Adult

We reported three types of newly designed arm slings (the "V" strap pouch arm sling, the Modified hemisling, the Tripod arm sling). The three slings and the conventional hemisling were all tested by a single stroke patient for the correction of shoulder subluxation. Sling effectiveness was evaluated by simple shoulder AP X-rays, quantitative electromyography (root mean square; RMS), strap tension, and preference of the patient. Of the four types, the "V" strap pouch arm sling reduced the vertical displacement the most. RMS values of the supraspinatus muscle tended decrease and strap tension was also lower after using the "V" strap pouch arm sling compared with others. The patient also preferred the "V" strap pouch arm sling to the other slings. We suggested that "V" strap pouch arm sling was the most effective among four types of arm slings (including conventional hemisling) for the correction of shoulder subluxation, and patient's preference.
Arm* ; Electromyography ; Humans ; Shoulder* ; Stroke*

OBJECTIVE: The purpose of this study was to identify the effect of EMG-triggered electrical neuromuscular stimulation for recovery of hemiplegic arm function. METHOD: EMG-triggered electrical stimulation was applied to the extensor digitorum communis (EDC) of 8 chronic hemiplegics who showed no functional changes for more than 3 months. Stimulation was started when the amplitude of processed EMG signal from the same muscle exceeded the preset threshold. The therapeutic effect was evaluated by kinesiologic and clinical methods before and after 4 weeks. Quantitative EMG from EDC, excursion of second metacarpophalangeal joint, and functional measurements were used. We also evaluated cognitive and perceptual effect on recovery of arm function. RESULTS: Subjects treated with EMG-triggered electrical stimulation showed significant gain in amplitude of quantitative EMG and excursion sum during maximal exertion comparing to those of pre-treatment (p<0.05). There was also an decrease of spasticity after treatment. But functional, perceptual and cognitive outcome were not changed significantly (p>0.05). CONCLUSION: These results suggest that EMG-triggered electrical stimulation might be an effective therapeutic modality to improve motor function of the hemiplegic arm of chronic brain injured patients.
Arm* ; Brain ; Electric Stimulation* ; Hemiplegia* ; Humans ; Metacarpophalangeal Joint ; Muscle Spasticity

OBJECTIVE: The purposes of these study were to evaluate the changes of temperature and sympathetic skin response (SSR) before and after sympathectomy in patients with palmar hyperhidrosis and to quantify long standing effect of sympathectomy. METHOD: The SSR and skin temperature were measured before, one day and 30 days after thoracoscopic sympathectomy. SSR was recorded from palm and sole bilaterally. Temperature was recorded on 9 sites of each hand and 11 site of each sole. Patient's satisfaction with operation was assessed by 10-point scale. RESULTS: One day after sympathectomy, the amplitude of SSR was significantly decreased and latency of SSR was delayed in all cases on bilateral palm and sole. However, after sympathectomy 30 days, the amplitude of SSR was normalized in all cases on bilateral sole. All patients who had undergone sympathectomy showed significant clinical improvement. The temperature increased dramatically over 3degrees C on postoperation 1 day and maintained 1.72degrees C higher in post-operation 30 days than pre-operation on both hands. There was no significant difference of temperature among pre-operation and post-operation 1 day and post-operation 30 days on sole. CONCLUSION: Our study proved effect of thoracoscopic sympathectomy to the patients with palmar hyperhidrosis objectively and quantified the decrement of sympathetic tone. Further study is needed for long term follow up over 2 months or more.
Follow-Up Studies ; Hand ; Humans ; Hyperhidrosis* ; Skin Temperature* ; Skin* ; Sympathectomy*

BACKGROUND: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients. MATERIALS AND METHODS: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group). RESULTS: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8–40%] vs. 47% [IQR, 15–62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20–18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08–18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47–34.58) were independently associated with the case group in multivariate analysis. CONCLUSION: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.
Adult ; Bronchoalveolar Lavage Fluid* ; Bronchoalveolar Lavage* ; Chungcheongnam-do ; Diabetes Mellitus ; Drug-Related Side Effects and Adverse Reactions ; Glomerular Filtration Rate ; Humans ; Korea ; Lymphocyte Count ; Lymphocytes* ; Medical Records ; Multivariate Analysis ; Odds Ratio ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Risk Factors* ; Salvage Therapy ; Seoul ; Treatment Failure

BACKGROUND: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients. MATERIALS AND METHODS: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group). RESULTS: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8–40%] vs. 47% [IQR, 15–62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20–18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08–18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47–34.58) were independently associated with the case group in multivariate analysis. CONCLUSION: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.
Adult ; Bronchoalveolar Lavage Fluid* ; Bronchoalveolar Lavage* ; Chungcheongnam-do ; Diabetes Mellitus ; Drug-Related Side Effects and Adverse Reactions ; Glomerular Filtration Rate ; Humans ; Korea ; Lymphocyte Count ; Lymphocytes* ; Medical Records ; Multivariate Analysis ; Odds Ratio ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Risk Factors* ; Salvage Therapy ; Seoul ; Treatment Failure

Listeria monocytogenes is a facultative anaerobic gram positive rod bacteria that is wide spread in the natural environment and found in soil, water, decaying vegetation, and as part of the fecal flora of many mammals. It is also a common cause for meningoencephalitis and bacteremia in at-risk groups including neonates, pregnant women, elderly persons, and immunocompromised patients. However, pneumonia with pleuritis is a very rare manifestation of L. monocytogenes. We report a case of pneumonia with pleural effusion caused by L. monocytogenes as isolated from the blood culture of a patient diagnosed with acute lymphoblastic leukemia resulting from induction chemotherapy. The patient recovered after the introduction of therapeutic thoracentesis and administration of intravenous ampicillin (2 g q 6 hr) plus gentamicin (1.7 mg/kg q 8 hr) over a two week period. This case demonstrated that L. monocytogenesis infection should be a consideration in the differential diagnosis of pneumonia and pleuritis in leukemic patients.
Aged ; Ampicillin ; Bacteremia ; Bacteria ; Diagnosis, Differential ; Female ; Gentamicins ; Humans ; Immunocompromised Host ; Induction Chemotherapy ; Infant, Newborn ; Listeria ; Listeria monocytogenes ; Mammals ; Meningoencephalitis ; Pleural Effusion ; Pleurisy ; Pneumonia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Pregnant Women ; Soil