BACKGROUND: A 9-year-old male showed severe defects in midface structures, which resulted in maxillary hypoplasia, ocular hypertelorism, relative mandibular prognathism, and syndactyly. He had been diagnosed as having Apert syndrome and received a surgery of frontal calvaria distraction osteotomy to treat the steep forehead at 6 months old, and a surgery of digital separation to treat severe syndactyly of both hands at 6 years old. Nevertheless, he still showed a turribrachycephalic cranial profile with proptosis, a horizontal groove above supraorbital ridge, and a short nose with bulbous tip. METHODS: Fundamental aberrant growth may be associated with the cranial base structure in radiological observation. RESULTS: The Apert syndrome patient had a shorter and thinner nasal septum in panthomogram, PA view, and Waters’ view; shorter zygomatico-maxillary width (83.5 mm) in Waters’ view; shorter length between the sella and nasion (63.7 mm) on cephalogram; and bigger zygomatic axis angle of the cranial base (118.2°) in basal cranial view than a normal 9-year-old male (94.8 mm, 72.5 mm, 98.1°, respectively). On the other hand, the Apert syndrome patient showed interdigitating calcification of coronal suture similar to that of a normal 30-year-old male in a skull PA view. CONCLUSION: Taken together, the Apert syndrome patient, 9 years old, showed retarded growth of the anterior cranial base affecting severe midface hypoplasia, which resulted in a hypoplastic nasal septum axis, retruded zygomatic axes, and retarded growth of the maxilla and palate even after frontal calvaria distraction osteotomy 8 years ago. Therefore, it was suggested that the severe midface hypoplasia and dysostotic facial profile of the present Apert syndrome case are closely relevant to the aberrant growth of the anterior cranial base supporting the whole oro-facial and forebrain development.
Acrocephalosyndactylia ; Adult ; Child ; Exophthalmos ; Forehead ; Hand ; Humans ; Hypertelorism ; Male ; Maxilla ; Nasal Septum ; Nose ; Osteotomy ; Palate ; Prognathism ; Prosencephalon ; Skull ; Skull Base ; Sutures ; Syndactyly

BACKGROUND: Ischemic stroke occurring during sleep is still an unexplored area of cerebrovascular event. As the exact onset time of stroke while sleeping (SWS) cannot be determined, these patients are generally excluded from the thrombolytic therapy of acute ischemic stroke. The aim of this study was to know whether differences in clinical features exist between patients suffering a SWS and those with stroke while awake (SWA). METHODS: We reviewed the medical records of acute ischemic stroke patients consecutively registered in Hallym Stroke Databank between January 1999 and June 2007. We compared the risk factors and clinical features between the SWS and SWA groups. RESULTS: A total of 2,962 patients were included in the study, of which 821 (27.7%) were SWS. No differences between SWS and SWA were identified with regard to baseline clinical characteristics and risk factors except a history of smoking. In stroke subtype, small vessel occlusions were more frequently in SWS group than SWA group. Intravenous rt-PA treatments were performed frequently in the SWA group. Clinical outcomes at discharge were better in SWA group than SWS group. CONCLUSION: This study suggest that no major differences were exist in clinical characteristics between SWS and SWA patients, except the history of smoking. Clinical outcomes of patients with ischemic stroke within 6 hours after stroke onset were poor in SWS group. In SWS group, relatively little chances of thrombolysis might be the explanation of these finding.
Glycosaminoglycans ; Humans ; Medical Records ; Risk Factors ; Smoke ; Smoking ; Stress, Psychological ; Stroke ; Thrombolytic Therapy

Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease of unknown etiology characterized by accumulation of calcium phosphate in the submucosa of large airways and benign proliferation of bone and cartilage resulting in nodular formation. We report a case of tracheobronchopathia osteochondroplastica diagnosed by Endobronchial ultrasonography in a 56-year-old man. Chest Computed Tomography revealed thickening of tracheal and bronchial wall, and multiple nodules through whole trachea. Endobronchial ultrasonography showed numerous submucosal nodules with hetero-echogenecity in the third and fourth layers. Histopathological examination revealed nonspecific bronchitis with squamous metaplasia and metaplastic ossification. We confirmed tracheobronchopathia osteochondroplastica. The patient's symptoms were successfully treated with antibiotics and oxygen supplyment. endobronchial ultrasonography can helpful diagnosis in tracheobronchopathia osteochondroplastica.
Anti-Bacterial Agents ; Bronchitis ; Calcium ; Calcium Phosphates ; Cartilage ; Humans ; Metaplasia ; Middle Aged ; Osteochondrodysplasias ; Oxygen ; Thorax ; Trachea ; Tracheal Diseases

PURPOSE: The purpose of this study was to classify posterior malleolar fractures according to the position of fragments and to analyze radiologic features of each type. MATERIALS AND METHODS: We analyzed forty-six patients of ankle fractures involving a posterior malleolus who were treated between January 2004 and December 2007. The posterior malleolar fractures were categorized into three types (posterolateral, posteromedial, shell) based on the major fracture line. In each type, we analyzed amount of displacement, involvement of articular surface, existence of subluxation and osteochondral impacted fragments. RESULTS: The forty-six patients were categorized into three types: Posterolateral (PL) type (33 cases, 72%), Posteromedial (PM) type (8 cases, 17%), shell type (5 cases, 11%). Of the 8 cases with PM type, 7 cases showed displacement more than Grade II, 4 cases showed subluxation of ankle joint, and 3 cases showed osteochondral impacted fragment. Average involvement of articular surface of PM type is 35% (15~65%). CONCLUSION: Posterior malleolar fractures with medial extension tended to have adverse effect on ankle stability and Preoperative CT scan is essential for evaluation of fracture type and determination of appropriate surgical approach.
Animals ; Ankle ; Ankle Joint ; Displacement (Psychology) ; Humans

Bipolar clavicular dislocation is simultaneous dislocation of both poles of the clavicle (mainly an anterior dislocation of the sternoclavicular joint and a posterior dislocation of acromioclavicular joint) and rarely reported. We report a case of bipolar claviclular dislocation after a seat belt injury and describe its presumed mechanism and treatment with a review of literature.
Clavicle ; Dislocations ; Seat Belts ; Sternoclavicular Joint

OBJECTIVE: The purpose of this study was to evaluate the stress distribution in bone and displacement distribution of the miniscrew according to the length and number of the miniscrews used for the fixation of miniplate, and the direction of orthodontic force. METHODS: Four types of finite element models were designed to show various lengths (6 mm, 4 mm) and number (3, 2) of 2 mm diameter miniscrew used for the fixation of six holes for a curvilinear miniplate. A traction force of 4 N was applied at 0degrees, 30degrees, 60degrees and 90degrees to an imaginary axis connecting the two most distal unfixed holes of the miniplate. RESULTS: The smaller the number of the miniscrew and the shorter the length of the miniscrew, the more the maximum von Mises stress in the bone and maximum displacement of the miniscrew increased. Most von Mises stress in the bone was absorbed in the cortical portion rather than in the cancellous portion. The more the angle of the applied force to the imaginary axis increased, the more the maximum von Mises stress in the bone and maximum displacement of the miniscrew increased. The maximum von Mises stress in the bone and maximum displacement of the miniscrew were measured around the most distal screw-fixed area. CONCLUSIONS: The results suggest that the miniplate system should be positioned in the rigid cortical bone with 3 miniscrews of 2 mm diameter and 6 mm length, and its imaginary axis placed as parallel as possible to the direction of orthodontic force to obtain good primary stability.
Axis, Cervical Vertebra ; Displacement (Psychology) ; Finite Element Analysis ; Traction

Ocular complications of HIV-related cryptococcal meningitis are reasonably common, but complete binocular blindness as the first manifestation of HIV is extremely rare. A 58-year-old man presented with binocular blindness. He experienced blurred vision for 3 days before the blindness. Mild pleocytosis was present in the cerebrospinal fluid, from which Cryptococcus neoformans was cultured. Serology revealed positivity for HIV antibody. He was treated with antifungal and antiretroviral therapy. This case indicates that HIV-related cryptococcal meningitis should be taken into consideration when determining the cause of unexpected sudden binocular blindness.
Blindness* ; Cerebrospinal Fluid ; Cryptococcus neoformans ; HIV ; Humans ; Leukocytosis ; Meningitis, Cryptococcal* ; Middle Aged ; Telescopes*

OBJECTIVES: Psychotic Symptom Rating Scale (PSYRATS) is an assessment tool to measure the severity of different dimensions of auditory hallucinations and delusions. The reliability and validity of the Korean version of PSYRATS (K-PSYRATS) were examined in Korean patients with major psychosis. METHODS: The inter-rater reliability of the K-PSYRATS was determined from the videotaped interviews of the five schizophrenic patients. To measure validity and internal consistency reliability, the 109 patients with auditory hallucinations or delusions were assessed using the K-PSYRATS, Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression-Severity (CGI-S) scale. RESULTS: K-PSYRATS was found to have excellent inter-rater reliability (intra-class correlation coefficient of auditory hallucination= 0.81, p<.001, intra-class correlation coefficient of delusion=0.97, p<.001) and internal consistency reliability (Cronbach's alpha of auditory hallucination=0.77, Cronbach's alpha of delusion=0.76). Significant correlation was found between K-PSYRATS and positive syndrome subscale of PANSS and CGI. CONCLUSION: K-PSYRATS is a useful assessment instrument for psychotic symptoms in Korea.
Delusions ; Hallucinations ; Humans ; Korea ; Psychotic Disorders ; Reproducibility of Results*

BACKGROUND: Although proactive screening for sexual dysfunction in primary care has been emphasized as an important part of comprehensive care, doctors seldom ask their patients about their sexual function. Worry about patients' responses was reckoned as a major barrier, but few studies have dealt with how patients feel and what they want. This study was aimed to describe and analyze the attitudes of patients toward proactive screening for sexual dysfunction. METHODS: A set of self-administered questionnaire was given to every patients who visited a family medicine clinic in a university hospital for 2 weeks from March 16, 2005. RESULTS: A total of 185 patients were analyzed. Among them, 72.4% were willing to consult their physician when they were in trouble with their sexual function, and 84.3% said proactive screening for sexual dysfunction was necessary. Many patients did not care about 'when to be asked' and wanted to be asked in face-to-face interview rather than by a questionnaire. Sentence emphasizing that every patient is given the same question was most preferred. CONCLUSION: Patients' attitude toward proactive screening for sexual dysfunction in primary care was generally positive. Patients preferred to be asked "I ask every patient about his sexual problem. If you're OK, I ask you about your sexual problem." regardless of timing, during the interview.
Humans ; Mass Screening* ; Primary Health Care ; Surveys and Questionnaires

The purpose of this project was to study the effect of growth hormone on early bony consolidation in distraction osteogenesis of a dog mandible. Sixteen dogs were used for this study. An external distraction device was applied to the mandibular body and the mandibular distraction was started five days after the operation at a rate of 1 mm per day up to a 10-mm distraction. Dogs in the growth hormone group received a daily subcutaneous injection of 1 IU of recombinant human growth hormone per kilogram of body weight per week. Normal saline was injected in the control group. Bone mineral density was higher in the growth hormone group than the control group in the whole period. Bone mechanical strength was 300% higher in the growth hormone group than that in the control group. However, results were more suggestive than conclusive. Upon histological examination, the formation of a substantial amount of active woven bone was observed throughout the distracted zone in 6 weeks in the growth hormone group. In the control group, new bone was generated from the edge to the center of the distracted zone. But, the most central area of the distracted zone was filled with fibrous tissue in 6 weeks. In conclusion, growth hormone appears to be effective in early bony consolidation in distraction osteogenesis.
Animals ; Body Weight ; Bone Density ; Dogs ; Growth Hormone* ; Human Growth Hormone ; Injections, Subcutaneous ; Mandible ; Osteogenesis, Distraction* ; Regeneration*