Perineal Reconstructive Surgery of a Cloaca-Like Perineal Defect: A Case Report

The perineal defect in female genitalia results from multiple etiologies, including obstetric injury, sexual assaults, and perineal trauma. Untreated defects may lead to significant physical, functional, and esthetic complaints. Numerous reconstruction methods are used for a perineal defect, but various complications, such as fecal impaction, fecal incontinence, and wound disruption, are introduced. We report a case of a 40-yr-old woman with a cloaca-like perineal defect, who was treated with reconstructive surgery of the perineal defect and recovered with a good anatomical and functional outcome.

The Treatment for Mandibular Condyle Fracture of Children by a Threaded Kirshcner Wire and External Rubber Traction

PURPOSE: The treatment of children mandibular condyle fracture that is severely displaced is controversial. The conservative treatment of it may lead to complications- mandibular deficiency, asymmetry, malocclusion and temporomandibular joint dysfunction. Moreover, open reduction carries risks for growth retardation, facial nerve injury, scarring and joint stiffness. The aim of this article is to present an alternative technique of the treatment by using a threaded Kirschner wire and external rubber traction. METHODS: From November 2005 to May 2008, three patients underwent the management by using a threaded Kirschner wire and external rubber traction. A threaded Kirschner wire was inserted in the condylar segment by using a C-arm. We applied the external rubber traction, and we reducted the segment progressively until complete reduction. The mandibular-maxillary fixations were removed after 3 weeks, and patients were sent to training for mouth opening. RESULTS: The technique didn't result in complications- joint dysfunction, facial nerve injury, sore, infection and nonunion during follow-up period. Radiologic follow-up examinations revealed correct reduction in all patients. In all cases, we found restoration of preinjury occlusion and temporomandibular joint function. CONCLUSION: Closed reduction of children mandibular condyle fracture by using a threaded Kirschner wire and external rubber traction did achieve anatomic reduction and restore mandibular height. This alternative technique is simple, effective, inexpensive, easy to apply and minimally invasive.

Characteristics of Nasal Trauma in the Implanted Nasal Prosthesis

PURPOSE: Presently, silicone rubber is chosen most frequently for nasal augmentation. However, there is a possibility of extrusion with this material. Sometimes, noses are prone to be traumatized, and then silicone rubber has a possibility of deformity or deviation resulting in trauma. We experienced cases with complications and traumatic deformities after the augmentation rhinoplasty. METHODS: A retrospective review was performed to determine the characteristics of the implanted nasal silicone prosthesis after trauma. The patients' data such as deviation of implant, shape of fracture, age and sex of the patient, time of treatment, operative methods were reviewed. From March 2001 to March 2008, this study was performed in 30 patients. The patients were 25 females and 5 males, from 24 to 60 years of age, with an average of 42. All patients had previous augmentation rhinoplasty with silicone implant. RESULTS: All of the 30 patients were confirmed as deviation of silicone and nasal bone fractures in the facial bone CT scan. The most common cause of fracture was traffic accident. The classification of nasal trauma after augmentation was done by facial bone CT. Class I: Deviation of silicone without nasal bone fracture without extrusion(12 cases, 40%), Class II: Deviation of silicone without nasal bone fracture and with extrusion(4 cases, 13%), Class III: Deviation of silicone with nasal bone fracture and without extrusion(8 cases, 27%), Class IV: Deviation of silicone with nasal bone fracture and with extrusion(3 cases, 10%), Class V: Mild deviation of silicone with nasal bone fracture(3cases, 3%). Specially, the comminuted or trapezoid nasal fracture was confirmed in 11 cases(Class III, IV). CONCLUSION: The problems of silicone implant have generally been related to foreign body reactions, rigidity of the material, encapsulation, infections, and extrusion. We experienced 11 cases of comminuted or comminuted trapezoid shaped fracture below nasal implant. So, we think this phenomenon could be used in late problem of silicone implant.

A Case of Sjogren Syndrome in Parotid Gland

Sjogren syndrome is a chronic disorder characterized by immune-mediated destruction of exocrine glands predominantly but not exclusively on the lacrimal and salivary glands. The common clinical manifestations of Sjgren syndrome include xerophthalmia with secondary keratoconjunctivitis and xerostomia, with or without salivary gland enlargement. Minor salivary gland biopsy usually demonstrates heavy lymphocyte infiltration, although parotid gland biopsy may be more sensitive and specific. Rheumatoid factor and antinuclear antibodies are high in Sjgren syndrome patients. We report a case of Sjogren syndrome with parotid gland involvement in a 44-years-old female patient with xerostomia, xerophthalmia and Rheumatic arthritis. We did total parotidectomy in right parotid gland and superficial parotidectomy for left side parotid gland was done after 20 days. Histologic and immunohistochemical studies revelead multiple periductal lymphoid proliferation and chromic inflammation, lymphoid hyperplasia in parotid glands.

Tumors of the Parotidomasseteric Area Associated with Inadequate Primary Treatment: Report of 2 Cases

PURPOSE: Parotid neoplasia are relatively frequent, representing approximately 3% of all tumors in the head and neck regions. But incomplete resection and misdiagnosis of parotid gland is followed by multiple tumor invasion, tumor recurrence, and other iatrogenic tumor formation. In patients undergoing parotidectomy for confirmed or suspected malignancy, the traditional or modified rhytidectomy incision may prove suboptimal because it does not easily lend itself to a continuous neck dissection. Similarly, patients with tumors of the anterior accessory lobe or patients with large anterior tumors may also require the modified Blair incision for adequate surgical exposure. This report serves to revisit the topic of accessory and parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of recurrence are avoided. METHODS: This is a retrospective review of our experience with two cases of parotid tumors; one accessory parotid gland neoplasm and one parotid gland neoplasm. We report the case of parotid tumor and epidermal cyst in a 54-year old male patient and the case of case of recurrent parotid tumor with local invasion in 30-year old male patient. RESULTS: All were removed through a modified Blair incision. Pathologic report notified that One was found pleomorphic adenoma and epidermal cyst, and the other one pleomorphic adenoma with subcutenous invasion. The patients recovered well without any complication such as infection, hematoma, facial nerve palsy, and necrosis of skin flap. Patients were discharge POD#7. Patients were followed up to for 1 year and they have no sign of recurrence. CONCLUSION: A high index of suspicion, prudent diagnostic skills(including fine-needle aspiration biopsy, CT, US), and meticulous surgical approach are the keys to a successful management of these lesions. We experienced two cases of parotid neoplasia, in the treatment of tumor reccurence & iatrogenic tumor arising from the parotid gland and are presented with the review of literatures.

Quantity and Quality Assessment of Randomized Controlled Trials Published in Five Korean Medical Journals, from 1980 to 2000

BACKGROUND: As evidence-based medicine is getting popular recently, the importance of randomized controlled trial as a research methodology is also getting highlighted. This study was conducted in order to identify the status quo of randomized controlled trial research in major domestic journals and to provide baseline data for constructing Korean clinical trial database such CCTR (Cochrane Clinical Trial Registry). METHODS: Five journals issued by domestic publication industry were selected, out of which 127,560 original articles, equal to 253 volumes, were investigated. The author extracted the articles, which performed prospective clinical trial, targeting human beings. The selected papers were analyzed with experts to single out randomized controlled trial among them. Furthermore, the quality of the re-selected ones were assessed according to Jadad Quaility Assessment Scale. RESULTS: After analysis, it turned out that the number of papers adopting prospective clinical trial were 406 volumes (3.2%) of 12,760 and that they increased from 157 in 1980s to 224 in 1990s. However, the percentage of prospective clinical trial monographs, introduced during 1980s and 1990s, remained 2.0 to 4.0. The number of randomized controlled trial-based papers were 115, accounting for 0.9% of total articles. The number of RCT increased to approximately two fold from 1980s to 1990s. Quality analysis showed that among a total of 115 RCT papers, those of scoring 1 and 3 were 16 (13.9%), 82 articles obtained score 2 (72.2%). There was no papers, which won the marks of 4 and 5. CONCLUSION: It was found that domestic randomized controlled trial research was weak both in number and quality. Therefore, it is necessary to activate clinical medicine study with good quality to upgrade the amount and quality of monographs.

Chinical Analysis of Lower Leg Reconstruction with Free Flaps (47 Cases)

Traumatic injury to the lower legs has been increasing in Korea and often leads to skin and soft tissue loss, exposing blood vessels, nerves, tendons or bones. Salvaging these legs often requires free flaps. Over the past two decades, the use of free tissue transfer has produced an increasing salvage rate for severely injured lower leg. Between April. 1988 to July, 1997, 47 cases of lower soft tissue defects were reconstructed with free flaps, and retrospective analysis was performed to determine more about the factors associated with free flap failure or immediate vascular complications. We evaluated wound status before operation, operation time after injury, vascular status of recipient site, use of vein graft, use of reverse flow, salvage protocol in compromised anastomosis, survival rate and complications. There were 9 cases of venous thrombosis and 2 cases of arterial insufficiency while 7 out of 9 cases of venous thrombosis were reexplorated. However, 2 cases of partial flap necrosis and 1 case of total necrosis. Two cases of arterial insufficiency were necrotized, so the overall free flap failure rate was 9.6%. The results were analyzed to determine the factors promoting either failure or vascular complication, Many factors which are often blamed for failure (trauma cause, preoperative general condition, preoperative infection status, intraoperative ischemic time) were not significant in this study, but prolonged time after injury correlated with free flap failure, We concluded the adequate debridement and infection control, adequate selection of recipient vessel, accurate vascular anastomosis and most of all, early free flap transfer after injury, will improve the success rate.

Clinical Analysis of the Removed Nasal Implants

No abstract available.

Utilization of Alternative Therapies in Cancer Patients / 대한암학회지

PURPOSE: To determine patient's use of alternative cancer therapies, as well as the characteristics of the patients who used these therapies, descriptive study was conducted at the one college hospital in Seoul. MATERIALS AND METHODS: Of 950 eligible patients who discharged from October 1, 1996 to Febrary 28, 1997, 283 patients were completed semistructured questionnaire telephone survey finally(response rate is 29.8%). RESULTS: Alternative therapies were used by 53.0% of patients. The preferred was dietary therapies and oriental(herbs, acupucture) therapies, folk therapies, drug therapies were other popular methods. Any patient characteristics except time prolongation after diagnosis were not associated with use of alternative therapies. The patients were seeking for alternative therapy because they thought conventional medical treatments were not enough to expect to improve their health, The major source of information was relatives and friends, not the mass media. 46.6% of the patients used althenative therapy said that it were not effective but 30.4% of them said it would help to slow the progression of their disease or strengthen their resistance. 45.0% of them were satisfied with it. CONCLUSION: A significant proportion of cancer patients use one or more forms of alternative therapy. The physicians should recognize and give due consideration to the patients underlying desire for better control of his disease, and should be able to advise his patients on the use of alternative therapy.

A Case-Control Study of Primary Liver Cancer and Liver Disease History / 예방의학회지

The relationship between past liver disease history and the risk of primary liver cancer was analyzed in a hospital-based case-control study conducted in Seoul on 165 patients with histologically or serologically confirmed hepatocellular carcinoma and individually age-and sex-matched 165 controls in hospital for ophthalmologic, ontologic, or nasopharyngeal problems. Significant association were observed for liver diseases occurring 5 or more years before liver cancer diagnosis[OR, 4.9;97% confidence interval(CI), 1.6~14.0) and family history of liver disease(OR, 9.0;95% CI, 2.1~38.8). These associations were mot appreciably modified by allowance for major identified potential confounding factors, From these results, it is possible to speculate that liver cell injuries caused by Considering the significant effect of family history of liver diseases on PLCA risk after adjusting past liver disease history, there might be genetic susceptibility in the carcinogenic mechanism of liver cancer. Further investigations are needed to clarify the effect of family history of liver disease on PLCA risk.

Incidence rate of hepatitis B: results of a record linkage study among healthy Korean males

A stable, liver disease-free cohort of 369,725 was reconstructed as of 1984 for the study of hepatitis B virus seromarkers and liver diseases. The cohort consisted of male beneficiaries of the Korea Medical Insurance Corporation (KMIC) over 30 years of age and living nationwide. Subjects who were both negatives for HBsAg and anti-HBs (N = 274,037) were selected for incidence of hepatitis B. Data on test results of HBsAg and anti-HBs in 1984 and on hepatitis B occurrence during 1985-1986 were collected from the files of the KMIC. Linkage was done between these two data sets to measure the incidence rate through a longitudinal observation of the male population. Correction against misclassification error and duplicate claims was done by a sample survey and verification procedures. The incidence rate of hepatitis B was 17.13 per 100,000 person-years for acute viral hepatitis B and 15.74 for chronic hepatitis B, respectively. An increasing age-dependent pattern for acute hepatitis B was not so prominent in this population. However, the incidence rate of chronic hepatitis B steadily increased with age. The relative risk, estimated by a log-linear model for rate and constant hazard, was significantly higher in the over-60 age group than in the others. The incidence rate in the lower socioeconomic class was higher than in the others, although statistically not significant.