Strategies of upper blepharoplasty in aging patients with involutional ptosis

In many aging individuals, dermatochalasis and involutional ptosis appear together. Therefore, for functional and aesthetic purposes, ptosis correction and upper blepharoplasty are performed together. The aim of this article is to investigate factors that should be considered in order to achieve good results when simultaneously performing involutional ptosis correction and upper blepharoplasty in aging patients. Involutional ptosis is usually corrected through aponeurosis advancement in mild cases. In moderate or severe ptosis, the Muller muscle and aponeurosis are used together to correct ptosis. Using the two muscles together has the advantages of reducing lagophthalmos and increasing the predictability of outcomes after surgery. Broadly speaking, the surgical method used for involutional ptosis varies depending on the specific case, but unlike congenital ptosis, it is often not necessary to perform overcorrection. In particular, if there are problems such as severe dry-eye symptoms or risk of lagophthalmos, undercorrection should be considered. When performing ptosis correction, the surgeon should be careful not to overdo skin excision; instead, limited excision should be performed. After ptosis surgery, the brow may descend and the double fold may look too small. However, in order to make the double eyelids look larger, the surgeon should consider making the double eyelid design high rather than excising an excessive amount of skin. In some cases, to obtain more natural double eyelids and favorable results, it may be necessary to perform a sub-brow lift or forehead lift before or after involutional ptosis surgery.

The Determinants of the Quality of Life and Pain of Back Pain Patients / 예방의학회지

OBJECTIVES: Because of the changing life style of Koreans, we have witnessed an increase of patients with back pain. The development of medical knowledge and technology has resulted in more numerous and better treatment methods. However, the outcomes of diverse treatments have been examined by using a few medicine-oriented measures like pain. This study aims at identifing the factors that influence the outcomes of back pain treatments by using two outcome measures (e.g., quality of life and pain). METHODS: We used the questionnaire survey method for data collection. The questionnaires contained 5 categories(treatment methods, clinical conditions, exercise, quality of life and, socio-demographic characteristics). We interviewed 188 back pain patients. We used the regression analysis method to predict the quality of life or pain. RESULTS: Surgery showed a statistically significant effect on the quality of life as well as pain. The illness period, age and exercise were turned out to be significant factors for both of the dependent variables. The social class and surgery methods showed a statistically significant effect solely on the quality of life. CONCLUSIONS: In choosing the surgical methods, doctors need to provide detailed explanations on the quality of life outcomes for each of the surgical methods to the patients.

Blepharoptosis Correction with Muller Tuck Method

There are several methods for blepharoptosis correction. Many complication of blepharoptosis induced by operation. Lid lag and lagophthalmos is especially, a difficult problem to resolve. So, many plastic surgeons make an effort to prevent lid lag or lagophthalmos. One of blepharotposis correction methods, we have used Muller's muscle tucking method since 2004. The author's method is Muller's muscle tuck with fixation to the tarsal plate and pretarsal fascia with nylon #6-0 and aponeurosis sutured with pretarsal orbicularis muscle or pretarsal area dermis. We have found this method to show good results, with resulting no or only mild lagophthalmos than previous ptosis corrective methods. This method yield results with more post-operative predictability than aponeurosis surgery due to preservation of the aponeurosis gliding plane. If this method is applied to mild and moderate ptosis, it is one of good method of ptosis correction.

A Case of Dicamba Poisoning with Rhabdomyolysis and Acute Renal Failure Treated by Hemodialysis / 대한신장학회잡지

Dicamba is 3, 6-dichloro-2-methoxybenzoic acid and classified as a chemically related chlorophenoxy herbicide. This herbicide has been widely used for control of broad-leaved weeds. The poisoning is uncommon and of low toxicity, but massive self-ingestion may be fatal. We experienced a case of dicamba poisoning with rhabdomyolysis and acute renal failure in a 53-year-old male. This patient showed vomiting, confused mental status, and myotonia. Electrolyte abnormalities, rhabdomyolysis, and acute renal failure also developed together with fever, hepatotoxicity, pancreatic toxicity, hematologic abnormalities and cardiac ischemia. He was treated by 7 sessions of hemodialysis with supportive treatment and recovered.

Hart's survival curve are Very Useful for Predicting Prognosis in Paraquat Poisoning / 대한신장학회잡지

BACKGROUND: Paraquat is highly toxic herbicide used in agriculture, and mortality of paraquat poisoning is very high. The predictions of severity of poisoning assessed with the amount of ingestion, results of urine dithionite test and laboratory findings are not accurate. The aims of this study are to investigate whether Hart's probability of survival curves are useful for predicting outcomes of paraquat-poisoned patients and which factors influence the outcomes of the patients. METHODS: We grouped 175 patients with paraquat poisoning into seven groups using curves of probability of survival suggested by Hart, et al. Group A was patients with plasma paraquat concentration below 90% probability of survival curve, group B patients with paraquat levels between 90% and 70% probability of survival curves, group C patients with paraquat levels between 70 and 50% probability of survival curves, group D the ones with paraquat levels between 50% and 30% probability of survival curves, group E the ones with paraquat levels between 30 and 20% probability of survival curves, group F paraquat levels between 20 and 10% probability of survival curves, and group G patients with paraquat levels above 10% probability of survival curve. And we analyzed the survival and mortality rates of each groups. RESULTS: The mortality rates of groups A, B, C, D, E, F and G were 7.4%, 26.7%, 37.5%, 55.6%, 63.6 %, 83.3% and 96.8% respectively (p<0.0005). The most important risk factor for death of patients was the paraquat concentration grouping with odds ratios (95% CI) of 4.4 (0.7-27.5, group B), 7.2 (0.9-54.9, group C), 15.0 (52.1-105.6, group D), 21.0 (3.2-139.7, group E), 60.0 (7.4-487.1, group F), and 359.9 (56.9- 2277.9, group G). CONCIUSION: In assessing prognosis of patients with paraquat poisoning, grouping of the patients using initial plasma paraquat concentrations is the most important, and the policy of treatment can be decided according the results.

Hart's survival curve are Very Useful for Predicting Prognosis in Paraquat Poisoning / 대한신장학회잡지

BACKGROUND: Paraquat is highly toxic herbicide used in agriculture, and mortality of paraquat poisoning is very high. The predictions of severity of poisoning assessed with the amount of ingestion, results of urine dithionite test and laboratory findings are not accurate. The aims of this study are to investigate whether Hart's probability of survival curves are useful for predicting outcomes of paraquat-poisoned patients and which factors influence the outcomes of the patients. METHODS: We grouped 175 patients with paraquat poisoning into seven groups using curves of probability of survival suggested by Hart, et al. Group A was patients with plasma paraquat concentration below 90% probability of survival curve, group B patients with paraquat levels between 90% and 70% probability of survival curves, group C patients with paraquat levels between 70 and 50% probability of survival curves, group D the ones with paraquat levels between 50% and 30% probability of survival curves, group E the ones with paraquat levels between 30 and 20% probability of survival curves, group F paraquat levels between 20 and 10% probability of survival curves, and group G patients with paraquat levels above 10% probability of survival curve. And we analyzed the survival and mortality rates of each groups. RESULTS: The mortality rates of groups A, B, C, D, E, F and G were 7.4%, 26.7%, 37.5%, 55.6%, 63.6 %, 83.3% and 96.8% respectively (p<0.0005). The most important risk factor for death of patients was the paraquat concentration grouping with odds ratios (95% CI) of 4.4 (0.7-27.5, group B), 7.2 (0.9-54.9, group C), 15.0 (52.1-105.6, group D), 21.0 (3.2-139.7, group E), 60.0 (7.4-487.1, group F), and 359.9 (56.9- 2277.9, group G). CONCIUSION: In assessing prognosis of patients with paraquat poisoning, grouping of the patients using initial plasma paraquat concentrations is the most important, and the policy of treatment can be decided according the results.

A Case of Milk-Alkali Syndrome Due to Calcium Carbonate Overdose / 대한신장학회잡지

Milk-Alkali syndrome can be caused by ingesting large amount of calcium and absorbable alkali. Coincident with promotion of calcium therapy for the treatment of osteoporosis in postmenopausal women and secondary hyperparathyroidism in patients with chronic renal failure, the Milk-Alkali syndrome is now a common cause of hypercalcemia. We experienced a case of a woman who had took calcium for hypoparathyroidism after thyroidectomy (and incidental parathyroidectomy) for thyroid papillary adenocarcinoma. Recently she ingested unusually large amount of calcium (10.8 g/day) for a week mistakenly. She presented voiding difficulty, anorexia and irritability with the triad of hypercalcemia, metabolic alkalosis and acute renal failure. All the metabolic abnormalities were normalized and renal function was improved with fluid and diuretic therapies.

A Case of Proliferative Glomerulonephritis with Monoclonal IgG Deposits / 대한신장학회잡지

Proliferative glomerulonephritis with monoclonal IgG deposits is a novel disease entity characterized by (1) glomerular monoclonal IgG deposits restricted to a single IgG subclass and a single light chain isotype, associated with proliferative GN; (2) granular deposits by EM; (3) no clinical and laboratory evidence of cryglobulinemia. A 47-year-old male presented with edema and muscle cramps. Urinalysis revealed protein 3+ and 5-9 RBC's/HPF. BUN/Cr were 25/1.7 mg/dL, 24 hour urine protein 5.4 g/day, and CCr 56.3 mL/min/1.73m2. Cryglobulin was negative. The histologic findings of the renal biopsy showed mesangial cell proliferation with double contour of GBM on LM, diffuse finely granular electron-dense deposit in subendothelial & mesangial area with no amyloid fibril on EM, and strong immune reactivity to IgG and kappa light chain along the glomerular basement membrane on IF. Serum and urine protein EP, IEP and immunofixation EP showed no evidence of monoclonal gammopathy. Bone marrow aspiration & biopsy were negative for plasma cell infiltration. The patient is on supportive management with an AII blocking agent.

A Case of Successful Endoscopic Therapy in Iatrogenic Perforation of the Colon during Colonoscopy / 대한소화기내시경학회지

Colonoscopy is a safe and standard procedure for diagnosis and therapy of colonic disorders. Iatrogenic colonic perforation during diagnostic colonoscopy, a rare abdominal emergency, has an 0.3~0.8% incidence rate. The choice of treatment for this complication remains controversial. Prompt operative intervention is preferred to minimize morbidity and mortality. However, operative intervention is invasive and needs a long-term recovery period. Conservative treatment is less invasive but can lead to more extensive surgery in case of treatment failure. Very important point on the treatment of iatrogenic perforation of the colon during diagnostic colonoscopy is to avoid the leaking of intestinal contents into the intraperitoneal cavity. We report here a case in which an iatrogenic perforation of the colon during diagnostic colonoscopy was successfully treated by endoscopic clip therapy.

Effect of immediate provisional restoration on the preservation of gingival contour / 대한치주과학회지

One of the central components of periodontal therapy is the improvement of esthetics. The presence and appearance of interdental papillae plays an important role of periodontal esthetics. The aim of the present study was to investigate how immediate provisional restoration preserve the shape of interdental papilla around the extraction socket and the width of bucco-lingual of gingiva. Another aim was to investigate the change in the interdental papilla and the amount of vertical bone fill of a extraction socket in relation to the interdental alveolar bone levels adjacent the alveolar socket. A total of 19 patients (11 male, 8 female, mean age of 50.57+/-8.16), who visited the Department of Periodontology, Pusan National University and had more than one anterior tooth scheduled to be extracted due to an advanced periodontal disease were included in the present study. After initial periodontal therapy, the extracted teeth were reshaped of the root and placed into the socket followed by splinting with adjacent teeth with self-curing resin. The width of bucco-lingual of gingiva and interdental papilla height were measured at baseline, 1, 3, 6, 9 and 12 month and the periapical radiographic examination were taken at baseline, 6 and 12month following the extraction. The amount of vertical bone fill in the extraction socket were calculated. At 12 months following the extraction, the changes in mesial and distal interdental papilla and the width of bucco-lingual showed -1.06+/-0.48mm, -0.84+/-0.50mm, -1.50+/-0.96mm, relatively. The positional change in the interproximal papillae was significantly associated with the interdental bone level adjacent to the extraction socket(p=0.028). The higher the interproximal bone level adjacent the extraction socket, the greater the amount of bone fill in the extraction socket(p<0.001). In conclusion, it was thought that immediate provisional restoration could minimize the loss of the width of bucco-lingual and interproximal papillae around the extraction socket. In addition, the higher the interproximal bone level adjacent the extraction socket, the greater the amount of bone fill and the smaller the reduction of papillary height around the extraction socket.

Huge Chondroid Syringoma of the Forehead: A case report

Chondroid syringoma also known as cutaneous mixed tumor of salivary gland type, is a relatively uncommon adnexal tumor of sweat gland origin. Most of these tumors are benign, although occasional malignant variants have been documented. Commonly, these tumors occur in the head and neck region but any part of the body may be affected. Their usual size is between 0.5-3.0cm. We treated a 47-years-old man was seen for tumor first noticed about 17 years ago on the forehead. This mass had been increasing in size slowly, An 8 x 8 x 9 cm size mass with surrounding subcutaneous tissue and overlying skin was excised from frontalis muscle fascia. On frozen biopsy, there was no malignant change. The wound was covered by skin graft. Microscopically, the mass is composed of glands or tubules, adipose tissue and hyalinized or chondromyxoid stroma(PAS:- , Alcian blue: +). Several areas show adenoic cystic carcinoma pattern, suspicous for early malignant change. No evidence of local recurrence has surfaced after 6 months of operation.

Modification of Le Fort III Osteotomy and Fronto-orbital Advancement for the Correction of Crouzon's Disease

In 1912, Crouzon reported one of craniofacial dysostosis, which was inherited as an autosomal dominant trait and characterized by craniosynostosis, midface hypoplasia, and exorbitism. In 1950, the first midface advancement was performed by means of a total facial osteotomy by Sir Harold Gillies. In 1967, Tessier accomplished complete craniofacial dysjunction by performing Le Fort III-Tessier I osteotomy on the basis of Le Fort III fracture and laid the foundation for modern craniofacial surgery. Variable combinations of the surgeries and osteotomies are performed considering functional disabilities as well as patient's age, general condition, and aesthetic problems. The nineteen-year-old female patient complained of frog-like face and showed severe exorbitism and midface hypoplasia, while the occlusion, being relatively normal. We applied modified Le Fort III osteotomy and fronto- orbital advancement. Over the follow-up period of six months, her previous normal occlusion was preserved and the exorbitism and midface deformity largely improved aesthetically.

Orbital Volume Change Measured by Computed Tomography in Blow Out Fracture

Enophthalmos is a common result of blow out fracture of the orbit. Prior to CT volume analysis no reliable measurement of the degree of bony and soft tissue deformity was available to identify patients who would develop enophthalmos. Evaluation of orbital volume expansion and volume expansion percentage were performed in 23 patients with blow out fracture, after 1-4 days of injury. All studies were performed on a CT (Somatom Plus, Germany, Siemens), using transaxial scan technique(140 kVp, 206 mA, 3 mm contiguous sections). The radiological boundaries of the orbit were defined anteriorly by a line mrrecting the anterior surface of the zygomaticofrontal process to the nasomaxillary suture and posteriorly to the optic foramen. The Hounsfield Unit(HU) ranges were -100 to 0 and 0 to +100. It is difficult to distinguish blood from fat in the orbital volume measurement. We used three methods to obtain more accurate orbital volume. First, The concave margin or the air meniscus surface area is blood and the convex margin area is fat. Second, It can be distingushed blood from fat by Hounsfield Unit of specific area pixel. Third, The homogenous area is blood and inhomogenous area is fat or mixture of fat and blood. The patients(> or =13% orbital volume expansion) are managed surgically. 15 patients were classified in operative group and 8 patients were in conservative treatment group. The volume expansion percentage is 12.7% to 28.8% in operative group and 4.2% to 11.2% in conservative group. There was no enophthamos in each groups after 3 months of operation and injury. CT measurements of orbital volume expansion and volume expansion percentage can predict the final degree of the late enophthalmos and may facilitate the planning of surgical intervention. To obtain more accurate prediction of enophthalmos, we consider not olny volume expansion but also volume expansion percentage, because everyone doesn't have the same normal orbital volume.

A comparisin of the Operative Results and Costs Between Interosseous Wiring and Miniplate Fixation in Open Reduction of Mandible Fracture

Mandible fractures have recently been managed by rigid internal fixation with miniplate and screws more often than by traditional interosseous wiring methods. The purpose of this paper was to compare traditional interosseous wiring with miniplate fixation in open reduction of mandible fracture, especKweonially in operative results and costs. From June of 1989 to June of 1998, there were 142 patients, admitted to the department of Plastic and Reconstructive Surgery, Chun-Cheon Sacred Heart Hospital, Hallym University. Of those, 101 patients were managed by open reduction, and among them, 83 patients were treated with miniplate fixation, but 18 patients had recently been treated with interosseous wiring methods. No significant difference was noted between the two groups in terms of complications, but the overall cost of miniplate and screws was higher than interosseous wiring, while the mean operative time was longer in the group treated with miniplate fiation. The authors recommend interosseous wiring technique for patients with mandible fractures requiring open reduction and fixation, except for absolute indications of rigid internal fixation.

A Study of Partial Excision and Suvdermal Exicision in Surgical Treatment of Axillary Osmidrosis

There are 3 basic methods for surgical treatment of axillary osmidrosis; 1) method that removes only subcutaneous cellular tissue without removing skin 2) method that removes skin and subcutaneous cellular tissue en bloc, and 3) method that partially removes skin and subcutaneous cellular en bloc as well as removing the subcutaneous cellular tissue of the adjacent region. We studied the results of partial removal of the skin and subcutaneous cellular tissue en bloc, as well as the removal of subcutaneous cellular tissue of the adjacent region to compare the results of the bipedicled flap with the graft conversion method. There was no difference between two methods in results and complication rates. There are 3 advantage to this procedure. First, about 70-80% of apocrine glands were centrally distributed among the axillary hairbearing region therefore, resection of the central portion of axillary hair distribution area is important for good result. Second, the preservation of the subdermal plexus with careful excision of adjacent underlying subcutaneous tissue under the aid of the magnifying surgical loupe, is important for good wound healing. Third, the central excision of the axillary hair distribution area provides good exploration for undermining and defatting of the undersurface of the adjacent area, therefore it tooks a shorter operation time.