BACKGROUND: Conventional correction of malunioned zygoma requires complete regional exposure through a bicoronal flap combined with a lower eyelid incision and an upper buccal sulcus incision. However, there are many potential complications following bicoronal incisions, such as infection, hematoma, alopecia, scarring and nerve injury. We have adopted a zygomaticofrontal suture osteotomy technique using transconjunctival incision with lateral paracanthal extension. We performed a retrospective review of clinical cases underwent correction of malunioned zygoma with the approach to evaluate outcomes following this method. METHODS: Between June 2009 and September 2015, corrective osteotomies were performed in 14 patients with malunioned zygoma by a single surgeon. All 14 patients received both upper gingivobuccal and transconjunctival incisions with lateral paracanthal extension. The mean interval from injury to operation was 16 months (range, 12 months to 4 years), and the mean follow-up was 1 year (range, 4 months to 3 years). RESULTS: Our surgical approach technique allowed excellent access to the infraorbital rim, orbital floor, zygomaticofrontal suture and anterior surface of the maxilla. Of the 14 patients, only 1 patient suffered a complication—oral wound dehiscence. Among the 6 patients who received infraorbital nerve decompression, numbness was gradually relieved in 4 patients. Two patients continued to experience persistent numbness. CONCLUSION: Transconjunctival incision with lateral paracanthal extension combined with upper gingivobuccal sulcus incision offers excellent exposure of the zygoma-orbit complex, and could be a valid alternative to the bicoronal approach for osteotomy of malunioned zygoma.
Alopecia ; Cicatrix ; Conjunctiva ; Decompression ; Eyelids ; Follow-Up Studies ; Hematoma ; Humans ; Hypesthesia ; Maxilla ; Methods ; Orbit ; Osteotomy* ; Retrospective Studies ; Sutures ; Wounds and Injuries ; Zygoma* ; Zygomatic Fractures

BACKGROUND: Aging population correspond with an increase in the numbers of dementia patients. Dementia decreases the quality of life of patients and care-givers. However, current pharmacological treatment is limited by modest efficacy and adverse effect. Nonpharmacological treatment for dementia has been considered to be a substitute treatment. Recently we developed a special planned program for dementia with depression. The aim of this study was to evaluate therapeutic effect of this program. METHODS: We included patients aged 65 and older who diagnosed dementia with depression in a geriatric institution from April to June, 2006. We surveyed their sex, age, education period, and histories of hypertension, smoking, and alcohol intake. Patients in experimental group carried out our program, including cooking, painting, recreation, and activity, 9 times for 60 minutes a session. All included patients were checked Korean Mini-Mental State Examination (K-MMSE) and Korean Form of Geriatric Depression Scale (KGDS) before starting program and after 3 months when programs finished. RESULTS: There was no difference in demographic factors between two groups. K-MMSE was significantly improved in experimental group compared with control group (P = 0.01). And, the KGDS was significantly improved in experimental group compared with control group (P = 0.00). CONCLUSION: Multidivisional program for social skill improvement was effective on treatment for patients of dementia with depression. Nonpharmacological treatment for dementia with depression would be developed and studied to enhance the qualities of life of patients and care of dementia.
Aged ; Aging ; Alzheimer Disease ; Cooking ; Dementia ; Demography ; Depression ; Humans ; Hypertension ; Paint ; Paintings ; Quality of Life ; Recreation ; Smoke ; Smoking

PURPOSE: The renal manifestations of tuberous sclerosis complex (TSC) are remarkably diverse, including polycystic kidney disease, simple renal cysts, renal cell carcinomas, and angiomyolipomas. All of these occur in children as well as adults in TSC. Angiomyolipomas, which can cause spontaneous life-threatening hemorrhages, are by far the most prevalent and the greatest source of morbidity. Here, we will address our experience, adding to the literature on pediatric patients with TSC requiring evaluation and treatment for renal manifestations. METHODS: A retrospective analysis was made on 19 patients in whom TSC was diagnosed between May 2001 and Oct. 2005 at Severance Hospital. All patients had clinical diagnoses of TSC as defined by the 1998 tuberous sclerosis complex consensus conference. RESULTS: The patients consisted of 13 boys and 6 girls with a mean age of 7.3 years (range 1 to 22). The renal disease associated with TSC included angiomyolipoma in nine patients (47.4 percent), renal simple cyst in one (5.3 percent), hydronephrosis in one (5.3 percent) patient. Eight patients (42.1 percent) presented with normal kidney contours at abdominal ultrasonography. One patient underwent renal replacement therapy due to chronic renal insufficiency after nephrectomy. Hemorrhage from angiomyolipoma was not detected. CONCLUSION: In our review of 19 cases of TSC, renal manifestations are reported in 57.9 percent of patients. Asymptomatic angiomyolipoma associated with TSC grow gradually, although severe hemorrhages are rare. So patients with TSC should be followed up with serial computerized tomography or abdominal ultrasonography. And also, renal function should be monitored conservatively.
Adult ; Angiomyolipoma ; Carcinoma, Renal Cell ; Child ; Consensus ; Diagnosis ; Female ; Hemorrhage ; Humans ; Hydronephrosis ; Kidney ; Kidney Failure, Chronic ; Nephrectomy ; Polycystic Kidney Diseases ; Renal Insufficiency, Chronic ; Renal Replacement Therapy ; Retrospective Studies ; Tuberous Sclerosis* ; Ultrasonography

We evaluated the urological complications in 200 renal transplantations performed in the Department of Urology, Catholic Medical College between March 1969 and April 1986. The following results were obtained; 1. Of 200 cases of recipient 151 cases were male and 49 cases were female. 2. The ureteroneocystostomy was performed as the method of modified Politano-Leadbetter (intravesical approach) in 66 cases and modified Mackinnon (extravesical approach) in 134 cases. 3. Our incidence of urological complications in 200 renal transplantations was 7%1l4 cases). Postoperative complications developed in Il of the 66(l6.7%) who underwent intravesical ureteroneocystostomy and 3 of the 134(2.2%) who underwent extravesical ureteroneocystomy. 4. The details of the complications were as follows: 6 were ureteral obstruction, 5 ureteral leakage, 2 urine leakage from anastomosis site and 1 was bleeding from anastomosis site. 5. Operative method for urological complications were ureteroureterostomy (10) in ureteral obstruction(6) and ureteral leakage (4), ureteroneocystostomy (1) in ureteral leakage, simple suture (2) in bleeding(1) and urine leakage from anastomosis site(2).
Female ; Hemorrhage ; Humans ; Incidence ; Kidney Transplantation* ; Male ; Postoperative Complications ; Sutures ; Ureter ; Ureteral Obstruction ; Urology

No abstract available.
Intestinal Volvulus* ; Pregnancy*

Acute pancreatitis is associated with a wide variety of infectious agents including mumps, hepatitis B virus, Coxsackie virus, Mycoplasma, Legionella, Aspergillus and Toxoplasma. There are a few reports of acute pancreatitis caused by Mycoplasma pneumoniae infection abroad, but rare in Korea. We treated a case of acute pancreatitis in a 13-year-old girl who presented with nausea, vomiting, diarrhea and severe abdominal pain. The clinical and laboratory findings led to the diagnosis of acute pancreatitis; the cause was confirmed by serological evidence of mycoplasma pneumoniae infection. We report acute pancreatitis caused by mycoplasma pneumoniae infection and review the literature.
Abdominal Pain ; Adolescent ; Aspergillus ; Diagnosis ; Diarrhea ; Female ; Hepatitis B virus ; Humans ; Korea ; Legionella ; Mumps ; Mycoplasma pneumoniae* ; Mycoplasma* ; Nausea ; Pancreatitis* ; Pneumonia, Mycoplasma* ; Toxoplasma ; Vomiting

PURPOSE: Renal abscess is very rare in children and its diagnosis is difficult because symptoms are often nonspecific. In previous studies, only 15% to 25% of patients were reported to be diagnosed at the time of admission. Early diagnosis and treatment are important because mortality rate correlates positively with the time of diagnosis. The purpose of this study is to clarify the clinical features of children with renal abscess and to investigate the possible indicators of this disease for early diagnosis and proper treatment. METHODS: Twelve children diagnosed with renal abscess from Jan. 1996 to Jul. 2004 were included. The age of patients ranged from 5 months to 15 years. We retrospectively analyzed the demographics of patients, their symptoms, predisposing factors, diagnostic methods and causative organisms and the treatment modalities. RESULTS: Fever was the most common manifestation. Five children(42%) had vesicoureteral reflux. Renal ultrasonography and computerized tomography were the most frequently used imaging tools to detect renal abscess. Gram negative bacteria were isolated in 7 patients and Staphylococcus aureus grew in 2 patients. All patients received intravenous antibiotics and 4 patients underwent aspiration or drainage of renal abscess. The average admission duration was 30 days. CONCLUSION: Renal abscess should be included in the differential diagnosis of prolonged fever in children, especially when flank pain is combined. For early diagnosis and a better prognosis, patients should be promptly investigated with ultrasonography or computerized tomography.
Abscess* ; Anti-Bacterial Agents ; Causality ; Child* ; Demography ; Diagnosis ; Diagnosis, Differential ; Drainage ; Early Diagnosis ; Fever ; Flank Pain ; Gram-Negative Bacteria ; Humans ; Mortality ; Prognosis ; Retrospective Studies ; Staphylococcus aureus ; Ultrasonography ; Vesico-Ureteral Reflux

PURPOSE: Nutcracker syndrome must be considered when hematuria or proteinuria occurs in a healthy child. The purpose of this study is to investigate the prevalence of nutcracker syndrome among children with asymptomatic hematuria or proteinuria, and to obtain the ratios of the peak velocity of the left renal vein between the aortomesenteric portion and the hilar portion in children with asymptomatic hematuria or proteinuria in which nutcracker syndrome was excluded and to observe whether the ratios are affected by sex, age or urinalysis findings. METHODS: Using Doppler ultrasonography, we measured the flow velocity and obtained the peak velocity ratios of the left renal vein at the aortomesenteric portion and at the hilar portion of the left kidney in children with asymptomatic hematuria or proteinuria who visited the Division of Pediatric Nephrology, Severance Hospital from May 2001 to March 2004. RESULTS: Of 304 children with asymptomatic hematuria or proteinuria, 107 children(35.2%) were diagnosed with nutcracker syndrome. For 197 children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the mean ratio of the peak velocity was 2.54+/-0.73, which was not affected by sex, age or urinalysis findings. CONCLUSION: Nutcracker syndrome was the major cause of asymptomatic hematuria or proteinuria in children, comprising 35% of all cases. Doppler ultrasonography was helpful in the screening of nutcracker syndrome and prevention of its complications. For children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the peak velocity ratio of the left renal vein did not differ from that of normal children and was not affected by sex, age or urinalysis findings.
Child* ; Hematuria* ; Humans ; Kidney ; Mass Screening ; Nephrology ; Prevalence ; Proteinuria* ; Renal Veins* ; Ultrasonography, Doppler ; Urinalysis

PURPOSE: Conservative management of multicystic dysplastic kidney(MCDK) without nephrectomy has recently been advocated. The purpose of this study was to determine the clinical course of conservatively managed MCDK and to find out possible predictive factors for involution of MCDK by ultrasonography(US). METHODS: A retrospective analysis was made on 46 patients(26 boys and 20 girls) in whom MCDK was detected and had been traced by US between Dec. 1993 and Aug. 2005 at Severance Hospital. RESULTS: Median follow-up time was 30 months(range 2-102 months). All patients underwent radionuclide scans and voiding cystourethrograms. The serial follow-up US showed complete involution in 11(24%), partial involution in 19(41%), and no interval change or increased in cyst size in 13(28%) patients. Nephrectomy was done in 3 patients(7%) due to relapsing urinary tract infection(UTI) and severe abdominal distension. The mean age of complete involution of MCDK was 37 months(range 12-84 months). Episodes of UTI were present in 17 patients(37%) and additional genitourinary(GU) abnormalities were found in 22 patients(44%). Hypertension and renal insufficiency was complicated in one patient. No child developed malignant tumor. Univariate analysis showed that five variables were associated with complete involution of the MCDK; gender, site, UTI episode, additional GU abnormalities, and renal length on initial US. After adjusting using the Pearson model, the presence of additional GU abnormalities was exclusively associated with complete involution among the 5 variables(P=0.034). CONCLUSION: In our review of 46 cases of MCDK, non-surgical approach for patients with MCDK was advisable and we could predict poor prognosis when MCDK is associated with other GU anomalies.
Child* ; Follow-Up Studies ; Humans ; Hypertension ; Multicystic Dysplastic Kidney* ; Nephrectomy ; Prognosis ; Renal Insufficiency ; Retrospective Studies ; Ultrasonography ; Urinary Tract

Juvenile rheumatoid arthritis(JRA) is the most common major connective tissue disease in children. Renal involvement in JRA is rare. Among the renal lesions that have been reported in JRA, amyloidosis and drug-induced nephropathy are the most common. Crescentic glomerulonephritis in JRA has rarely been reported. We report a case of ANCA-associated pauci-immune crescentic glomerulonephritis in JRA. The patient was a 15-year old boy with a 3-year history of JRA. He presented with gross hematuria, proteinuria, positive p-ANCA and elevation of BUN and creatinine. Pathologic findings revealed focal necrotizing and crescentic glomerulonephritis. There were no significant immunoglobulin or complement deposits. His renal function recovered after intravenous methylprednisolone pulse therapy and oral steroid use. In Korea, this is the first reported case of pauci-immune crescentic glomerulonephritis in JRA.
Adolescent ; Amyloidosis ; Antibodies, Antineutrophil Cytoplasmic ; Arthritis, Juvenile* ; Child ; Complement System Proteins ; Connective Tissue Diseases ; Creatinine ; Glomerulonephritis* ; Hematuria ; Humans ; Immunoglobulins ; Korea ; Male ; Methylprednisolone ; Proteinuria