Comparison of Computerized Tomography(CT) and Ultrasonography(US) in the Diagnosis of Nasal Bone Fracture and Medial Orbital Wall Fracture

For the diagnosis of nasal bone fracture and medial orbital wall fracture, plain radiography and computerized tomography(CT) have been utilized. But plain radiography is less reliable due to its low specificity. So CT has been given a preference to plain radiography in examining both fractures. However, CT has some disadventages; high expense, heavy radiation hazard, and coexistent injuries may restricted a patient,s positioning and so thus preventing or delaying the diagnosis. By comparison, ultrasonography(US) represents a safe, inexpensive, noninvasive, portable, and wide availability. This paper compares the relative values of CT and US in the diagnosis of both fractures. In nasal bone fracture, US proved to be more accurate than CT. Thirty-seven nasal bone fractures were diagnosed by US; whereas only thirty-two of these were revealed on CT. Compared with US, CT demonstrated 87% sensitivity. In examining medial orbital wall fracture, eight cases were diagnosed by CT; whereas seven of these were revealed on US. Compared with CT, US demonstrated 88% sensitivity. In medial orbital wall fracture, US was almost as accurate as CT. In this research, it is concluded that in the investigation of nasal bone fracture and medial orbital wall fracture, US is an accurate diagnostic modality and correlates well with CT.

Clinical Experience of an Angiosarcoma of the Scalp

Angiosarcoma is a rare malignant vascular tumor featuring endothelial cells. Angiosarcoma have four clinical manifestations that are angiosarcoma in the scalp and face, angiosarcoma in chronic lymphedematous areas, angiosarcoma in previously irradiated sites and malignant angioendothelioma. The most common lesions are those that occur in the scalp and in the face of elderly people. The male to female ratio is 2 : 1. In my case, a 65-years-old male presented progressively growing tumor on the left frontal scalp. The tumor began as an ill-defined bluish macule, which was initially mistaken for an old bruise. The rapidly growing lesion extended to form violaceousm compressible and hemorrhagic plaques. The mass was 6 x 4.5 cm in size. Distinguishing features are the frequent occurrence of a peripheral erythematous ring, satellite nodules, the presence of intratumoral hemorrhage, and the tendency to bleed spontaneously, or after minimal trauma. Histologically the tumor comprised anaplastic pleomorphic endothelial cells with new vascular channels and irregular vascular spaces lined by plump endothelial cell's stroma among them. The lesion was diagnosed as angiosarcoma. No metastasis to other organs were found as evaluated by chest CT, bone and liver scan. We performed wide excision, skin graft, bilateral transposition flap, chemotherapy and radiation. The tumor was recurred at 4 months after surgical excision and with metastasis to the lung. The progress was characterized by an extremely rapid growth accompanied by distant metastasis. Surgery, irradiation and chemotherapy having no effect on the final outcome, the patient died 7 months after diagnosis.

Clinical Experience of an Angiosarcoma of the Scalp

Angiosarcoma is a rare malignant vascular tumor featuring endothelial cells. Angiosarcoma have four clinical manifestations that are angiosarcoma in the scalp and face, angiosarcoma in chronic lymphedematous areas, angiosarcoma in previously irradiated sites and malignant angioendothelioma. The most common lesions are those that occur in the scalp and in the face of elderly people. The male to female ratio is 2 : 1. In my case, a 65-years-old male presented progressively growing tumor on the left frontal scalp. The tumor began as an ill-defined bluish macule, which was initially mistaken for an old bruise. The rapidly growing lesion extended to form violaceousm compressible and hemorrhagic plaques. The mass was 6 x 4.5 cm in size. Distinguishing features are the frequent occurrence of a peripheral erythematous ring, satellite nodules, the presence of intratumoral hemorrhage, and the tendency to bleed spontaneously, or after minimal trauma. Histologically the tumor comprised anaplastic pleomorphic endothelial cells with new vascular channels and irregular vascular spaces lined by plump endothelial cell's stroma among them. The lesion was diagnosed as angiosarcoma. No metastasis to other organs were found as evaluated by chest CT, bone and liver scan. We performed wide excision, skin graft, bilateral transposition flap, chemotherapy and radiation. The tumor was recurred at 4 months after surgical excision and with metastasis to the lung. The progress was characterized by an extremely rapid growth accompanied by distant metastasis. Surgery, irradiation and chemotherapy having no effect on the final outcome, the patient died 7 months after diagnosis.

Efficacy of Bactericidal Activity of Disinfectants and Antibiotics against MRSA

MRSA strains cause serious nosocomial infections. The rate of MRSA among Staphylococcus aureus isolated in Korea is about 70 - 80%. The treatment for MRSA infection is vancomycin. But vancomycin has several side effects and its therapeutic rate is 60 - 75%. Therefore the disinfectants play an important role in preventing and treating MRSA infection. In this study, 44 MRSA isolates were obtained from Wonkwang University Hospital, and examined for the efficacy of disinfectants commonly used in hospital. The tested disinfectants were chlorohexidine (Hibitan(R)), H2O2, tego, Gentian Violet, potadine, chlorohexidine gluconate (Microshield(R)), boric acid, alcohol, zepanon, acetic acid, and combinations of these disinfectants. MRSA studied were killed after exposure to chlorohexidine gluconate (Microshield (R)), alcohol, zepanon, alcohol+potadine, and alcohol+Gentian Violet within 30 seconds. But, tego, boric acid, and Gentian Violet+acetic acid could not kill MRSA after 30 minutes. Agar dilution minimal inhibitory concentration test was done with cephalothin, ciprofloxacin, clindamycin, erythromycin, fusidic acid, gentamicin, mupirocin, oxacillin, penicillin G, rifampin, tetracycline, and vancomycin. We found that bactericidal activity of vancomycin, fusidic acid, and mupirocin were good. In conclusion, this study provided useful information: 75% alcohol is the best disinfectant for wound dressing, 4% chlorohexidine gluconate(Microshield(R)) is useful for hand washing, and zepanon is useful for ward cleansing. Vancomycin-resistant Staphylococcus aureus was not found in our study.

The Therapeutic Effects of the Q-Switched Nd:YAG Laser on Pigmented Lesions

The Q-switched lasers which was introduced under the concept of selective photothermolysis. Q-switched Nd:YAG laser, which targets dark pigments in a longer wave length (1064 nm) that has less absorption by melanin, can effectively treat deep tattoos with less pigmentary alterations. We report our experience over the past 3 years in treating 565 patients with tattoos and cutaneous pigmented lesions using the Q-switched Nd:YAG laser. Patients were exposed with a pulse duration of 10 ns and fluences of 6, 7 J/cm2(1064 nm) or 12, 14 J/cm2(532 nm), in exposure spots of 2 mm or 3 mm, at intervals of 4 weeks. Q-switched Nd:YAG laser was effective in removing deep pigmented lesion with 1064 nm, and colored inks with 532 nm. Seventy-three percent of amateur black pigmented lesion were > 75% clear after four to ten treatment. Ninty-eight percent of professional black pigmented lesion were > 75% clear after two on eyebrow, six to eight on extremity and trunk. No significant side effects, including pigmentary changes or scarring, were noted.

Appearance of Vancomycin-Resistant Enterococci(VRE) on Sore Wound: A case report

Enterococcus is a gram positive coccus and a normal flora in gastrointestinal tract, but it could raise opportunistic infection. In 1986, vancomycin resistant enterococcus(VRE) was reported in Europe at first. Recently, the incidence is increasing in USA and Korea(2~8%). In our hospital, sore and stool cultures for enterococcal identification were carried out on 4 patients with sore wound. By screening stool culture, VRE was detected in 3 of 4 pressure sore patients. VRE was also identified from the sore wound in 2 of 3 patients who had VRE positive in screening stool culture. 2 of 4, enterococcal positive patients, have the history of vancomycin use in the past. An increasing number of VRE infection in hospital suggest that VRE become an important cause of infected pressure sore. Therefore, culture of sore wound and stool for the identification of VRE should be performed routinely.

Effects of Acetyl-L Carnitine on Recovery from Sciatic Nerve Injury in Rats

A possible therapeutic effect of acetyl-L carnitine (ALCAR) on peripheral nerve injuries and the expression of Jun, the protein products of immediate-early genes(IEGs), in the spinal cord were investigated after sciatic nerve injury in Sprague-Dawley rats. Experimental animals were divided into 3 groups: intact sciatic nerve as a control group, surgical repair alone, and surgical repair with ALCAR treatment. Toe-spreading response, pinprick response, and compound action potential were measured to evaluate the recovery of sciatic nerve injury. Recovery of behavioral function and electrophysiological function both improved in the surgical repair with ALCAR treatment group. Weak basal expression of Jun was shown in the ventral horn the of spinal cord in the control group. In the surgical repair alone group or the surgical repair with ALCAR treatment group, Jun expression persisted until 28 days after injury in the ventral horn of the spinal cord. Moreover, the surgical repair with ALCAR treatment group showed more increased expression of Jun than the surgical repair alone group. These results suggest that ALCAR facilitates the functional recovery after peripheral nerve injury.

Postracheostomy Scar Revision

The tracheostomy is increasingly being performed. In most cases, the tracheostomy sites are left to heal by secondary intention, so it leaves a depressed and wide scar that is cosmetically disfigured. Another problem os that the scar is also attached directly to the trachea itself and will move vertically with the trachea during the act of swallowing. Even though the tracheostomy scar is cosmetically acceptable, the mobility and retraction of the scar is a continual nuisance to the patient. We performed a retrospective study on 9 patients who had undergone revision of the depressed thracheostomy scar by the Renner Method from June, 1997 to February, 1999. The method includes transverse fusiform incision of the original scar and excision of the depressed portion of the scar to the level of the trachea itself. To prevent attachment of the skin and trachea, a bilateral subcutaneous flap and muscle flap were simply advanced to the midline and overlapped. Then the rest of scar that was not depressed was deepithelized and flipped to augment the soft tissue volume in the central depressed area. Satisfactory results were achieved in all patients without hematoma, infection, hypertrophic scar, and keloid formation. We believe this simple Renner method is one of the best ways of performing posttracheostomy scar revision.

Reconstruction of the Soft Tissue Defect Using Thoracodorsal Artery Perforator Skin Flap

In the case of a soft tissue defect which requires thin & pliable tissues, the choice of donor site is limited due to flap bulkiness and donor site morbidity. To overcome these problems, a variety of perforator-based flaps such as paraspinous and parasacral perforator flap, deep inferior epigastric perforator flap, gluteal perforator flap, and thoracodorsal artery perforator flap have recently been introduced. We experienced 8 cases of soft tissue defects from December 1996 to March 1999 using the thoracodorsal artery perforator flap for reconstruction. We could elevate the cutaneous flap with preservation of the latissimus dorsi muscle flap only when it was based on one cutaneous perforator. Defatting procedure was possible for further thinning of skin flap. In one case, axillary defect after release of postburn scar contracture was repaired with island perforator flap and the other seven cases were repaired with free flap. The results were satisfactory. We believe the thoracodorsal artery perforator flap is useful for reconstruction of soft tissue defects which are large or under conditions requiring thin flap.

A Study of The Relationship Between The Degree of Patient's Satisfaction with the Results of Aesthetic Operantion and Psychological Factors

No abstract available.

The effects of compound madecassol on the wound healing

This study was designed to assess the effects of compound madecassol(madecassic acid with neomycin sulfate and hydrocortisone acetate) on the wound healing. Madecassol is a titrated extract of centella asiatica and the clinical effects of madecassol are stated to the enhancement of wound healing and the prevention and relief of excessive scar formation. Compound madecassol is composed of madecassol and neomycin sulfate and hydrocortisone acetate. Neomycin sulfate has antibiotic effect and hydrocortisone acetate has antiinflammatory and antiallergic effects. So, compound madecassol has a synergistic effect of madecassol as well as neomycin sulfate and hydrocortisone acetate. Using 54 rats, we compared the effect of compound madecassol on wound healing at 3rd, 7th, 14th, and 21th postoperative days. This study examined the histologic findings and the gross findings which were wound size, epithelization and quality of granulation tissue. In this study, compound madecassol showed lower degree of inflammatory infiltration, shorter inflammatory phases and less wound contraction. The number of the myofibroblast in the group of compound madecassol were fewer than other groups. Granulation tissue of the compound madecassol was relatively healthier than others. There were no significant difference of re-epithelization between compound madecassol and other groups. In conclusion, compound madecassol can reduce excessive wound contraction and promotes wound healing process.

Clinical cases of deep inferior epigastric artery free skin flap

Since the use of the rectus abdominis myocutaneous flap was first reported by Mathes and Bostwick in 1977, its clinical utility both as an pedicled flap and a free flap has broadened reconstructive surgery. But there is a risk of postoperative abdominal hernia formation and bulkiness due to the volume of the rectus muscle and subcutaneous fatty tissue, it is pointed out as a disadvantage in the recipient site where a thin flap is required. To overcome these problems, Koshima (1989), and Itoth (1993) described the modification of this flap which contained little or no muscle or fascia. In our department , we performed deep inferior epigastric artery free skin flap in soft tissue reconstruction in three patients: we dissected one or two muscle perforator from the rectus muscle, removed the deep fatty layer, so we could elevate a thin flap. The results were good, so we are willing to describe the operative technique and its usefulness.

Lacrimal canalicular repairing using silicone intubation

Repairing of lacrimal canalicular laceration has some controversies on the golden time of surgery, the suture method, and the materials for stent. Recently, intubation of silicone tubes has become popular for repair of lacrimal canalicular injuries. Thirty-two cases of injured lacrimal canaliculi were repaired with use of silicone tube stents. The surgery can be done with monocanalicular(10 patients) or bicanalicular(22 patient) methods. The follow-up period was from two to eighteen months(mean ten months). Seven cases using the monocanalicular method and nineteen cases using the bicanalicular method were successful. Three cases of monocanalicular method had epiphora with canalicular obstruction due to early loss of the silicone tube. In monocanalicular method, postoperative complications were punctal granuloma(1 case), punctal slits(2 cases), and early loss of the silicone tube(3 cases). In bicanalicular method, postoperative complications were persistent epiphora during the period of intubaion(4 cases), conjunctival irritation sign(3 cases) and loop retraction(1 case). In conclusion, the success rate of bicanalicular stents were higher than that of monocanalicular stents for canalicular laceration. But the bicanalicular stent had some complications including cosmetic problem, possibility of injuries to the normal canaliculus during intubation, conjuntival irritation sign, and loop retraction.

RECONSTRUCTION OF CANALICULAR INJURY WITH MONOCANALICULAR TUBE

No abstract available.

EFFECTS OF SQUARE-PULSE STIMULATION ON FUNCTIONAL RECOVERY FOLLOWING A CRUSH INJURY TO THE SCIATIC NERVE IN RATS

Effects of square-pulse stimulation on the functional recovery following a nerve injury were examined in rats. a crush injury was made on the sciatic nerve under ketamine anesthesia and square-pulse stimulation with 5 - 7 V, 0.2 ms, 20 Hz, and 5 sec ON-OFF type was applied to the lesion site through teflon coated stainless steel wires(0.45mm in diameter) for 4 hours per day up to 2 days. Motor evoked potential(MEP) of the tibial nerve and somatosensory evoked potential (SSEP) of the T12 spinal cord were recorded. And their threshold, amplitude and latency were then analyzed. 1. Threshold of MEP was 41+/-5 uA, and that of SSEP was 39+/-13 uA. 2. MEP was composed of 3 waves, i.e., N1, N2, N3, in which Nl was conducted by A alpha fibers and the others by the synaptic fibers from the spinal cord. 3. SSEP was also composed of 3 waves, in which N1 was conducted by IA, N2 to II, and to III fibers. 4. MEP and SSEP were abolished immediately after crush injury and SEsP was more sensitive, N1 disappeared faster than N2 and N3. 5. Evoked potentials were abolished by application of local anesthetics, in which N2 and N3 were more sensitive than Nl. 6. Electrical stimulation decreased thresholds evoked potentials down to 50% in MEP, and 30% in SSEP. 7. Electrical stimulation increased amplitudes of evoked potentials and decreased latencies following the injury. These results suggest that square-pulse stimulation is effective in promoting the functional recovery following a nerve injury, Study of MEP and SSEP may be useful parameters to evaluate the nerve function following an injury.

CLOSED REDUCTION OF ZYGOMATIC ARCH FRACTURE WITH EXTERNAL WIRE TRACTION UNDER FLUOROSCOPY

Recently, facial traumas are increasing due to expansion of motor vehicles and complexity of social life pattern. The zygoma bone is a prominent part of the midface and prone to be traumatized. Numerous approaches for reduction and fixation of zygomatic fractures have been described. Each reduction method has its advantages and disadvantages. The authors employed the external wire traction with fluoroscopy in cases of non-comminuted zygomatic arch fracture. The advantages of this method are a more accurate reduction under direct vision and takes a very short time. This procedure also can reduce the pain and edema after postoperation and possible under local anesthesia. With such method, we obtained satisfactory results cosmetically and functionally.