Four Flaps Technique for Neoumbilicoplasty

The absence or disfigurement of the umbilicus is both cosmetically and psychologically distressing to patients. The goal of aesthetically pleasing umbilical reconstruction is to create a neoumbilicus with sufficient depth and good morphology, with natural-looking superior hooding and minimal scarring. Although many reports have presented techniques for creating new and attractive umbilici, we developed a technique that we term the "four flaps technique" for creating a neoumbilicus in circumstances such as the congenital absence of the umbilicus or the lack of remaining umbilical tissue following the excision of a hypertrophic or scarred umbilicus. This method uses the neighboring tissue by simply elevating four flaps and can yield sufficient depth and an aesthetically pleasing shape with appropriate superior hooding.

A Ganglion Cyst of the Temporomandibular Joint

No abstract available.

Complication of Augmentation Mammoplasty using Polysaccharide Hydrogel Breast implant: Two Cases Report

After the use of silicone-filled breast implant was restricted in 1992, PIP Hydrogel (Poly Implant Prosthesis, France) was temporarily used as an alternative which is an organic polymer of polysaccharide and water. This case report draws attention to an unusual presentation following the insertion of a PIP Hydrogel implant for breast augmentation. The first case is about 43-year-old woman who has undergone breast augmentation using PIP Hydrogel implant was admitted to the hospital because of painful swelling in her right breast. On examination, the right breast was larger than the left. At the operation, it was found that the implant on the right side has a large tear in the shell. And the other case is about 47-year-old woman who had capsular contracture on the outer-lower quadrant of both breasts. She came to our institution to replace bigger implants. We removed existing both breast implants (170cc, subglandular), and replaced cohesive gel implant (300cc, submuscular). From 1992 to 2000, the breast implant filled with a polysaccharide gel had been widely used because of its viscoelastic properties and biodegradability. However, there is no long-term safety data that the filler material as a polysaccharide hydrogel is toxic to humans or not. We wish to highlight its unpredictability and unreliability.

Evaluation of CDSS for Drug Prescriptions Based on Success Measures / 대한의료정보학회지

OBJECTIVE: The Clinical Decision Support System (CDSS) for drug prescriptions was developed by integrating the computerized physician order entry (CPOE) system to support doctors and pharmacists in making correct decisions on prescribing drugs in line with the prescription guidelines by the Health Insurance Review Agency (HIRA). The objective of this study was to evaluate the performance of the CDSS with respect to system quality, information quality, and user satisfaction in reducing prescription errors. METHODS: The study was based on survey data from 38 hospitals that were using the CDSS for drug prescriptions. To identify factors influencing the performance of CDSS, multiple linear regression and chi-square analyses were performed. RESULTS: Regression analysis showed that the variables for system quality and information quality significantly influenced the overall system performance. Specifically, ease of understanding the results and terminology assystem quality measures significantly influenced user satisfaction. Furthermore, based on chi-square analysis, two independent variables (ease of understanding results and decision support functions) were statistically significant with respect to all four dependent variables (information satisfaction, system satisfaction, willingness to recommend to other hospitals, and drug safety). CONCLUSION: Based on this study, users should be educated to improve their understanding of the system,and system and information quality should be continuously monitored to improve user satisfaction.

A Tension-free Herniorrhaphy Using the Prolene Hernia System: Clinical Experiences

PURPOSE: The aim of this study was to detail clinical experiences with a new type of tension-free herniorrhaphy using the Prolene Hernia System (PHS) and analyze the system' usefulness. METHODS: We reviewed 48 cases of herniorrhaphy using PHS and 45 cases of conventional herniorrhaphy retrospectively by reviewing the medical records of patients undergoing either procedure between January 2000 and February 2005. RESULTS: There was no significant difference in the operation time (P=0.054) or the length of hospital stay (P=0.138) between the groups. However, the need for analgesic therapy in the PHS group was less than in the control group (P= 0.008). There were no serious postoperative complications, but wound complications occurred more often in the PHS group (6 seromas and 2 hematomas), and urinary retention occurred more frequently in the control group. The recurrence rate in the control group was 2.2% (1/45), but there were no recurrences in the PHS group for 46 months. CONCLUSION: Herniorrhaphy using the PHS is safe and effective as conventional surgery. It can be carried out under local anesthesia more easily, and it is less painful than the conventional surgery. We suggest that the PHS be widely adopted as a method of tension-free herniorrhaphy.

Clinical Analysis of the Hemorrhoidectomy with Pure Local Anesthesia

PURPOSE: We hoped to evaluate the possibility of substitution of the local anesthesia for the spinal anesthesia in hemorrhoidectomy. METHODS: We did Milligan-Morgan hemorrhoidectomy under local anesthesia for the sixty- eight patients from January 1998 to December 2005. These patients were compared with seventy-nine patients of spinal anesthesia, sampled with similar gender, age, a surgeon, retrospectively. We used a mixture of 0.5% lidocaine and 1:200,000 epinephrine into perianal skin and intersphincteric space. RESULTS: The male-to-female ratio was 1:1 in local anesthesia group and 1:0.84 in spinal anesthesia group. The mean age was 50 and 46 respectively. The number of excised pile was 3.9 and 3.8 respectively. The frequency of the analgegics injected within first 24 hours was 1.79 and 2.70 respectively (P=0.001). The frequency of the urinary catheterization was 0.07 and 0.69 respectively (P < 0.001). The first bowel movement after surgery was 1.2 days and 1.6 days respectively. The hospital stay was 6.4 days and 8.1 days respectively (P=0.06). CONCLUISIONS: Local anesthesia is simple, safe and effective in the hemorrhoidectomy.

Solid and Papillary Epithelial Neoplasm of the Pancreas in a Child: A case Report

Solid and papillary epithelial neoplasm (SPEN) of the pancreas is a rare tumor with low malignant potentiality that usually occurs in young females. Preoperative evaluation, especially radiologic tests, including ultrasonography and CT scan, is helpful in the diagnosis. These studies demonstrate a well-demarcated large mass with solid and cystic portions, frequently in the tail or body of the pancreas. Complete resection is usually curative, however local invasion and/or metastasis may occur. The authors report a case of a solid and papillary epithelial neoplasm of the pancreatic body in a 14-year old child at St. Benedict Hospital and review the literature.

A Case of Intestinal Perforation in Henoch-Sch nlein Purpura

Henoch-Sch nlein purpura(HSP) is one of the most common vasculitic diseases of childhood, referred to as a leukocytoclastic vasculitis affecting small vessels. Although HSP related gastrointestinal symptoms are seen in up to 80% of patients during acute illness, these symptoms are usually transient. However, some patients with HSP have gastrointestinal major surgical complications such as intussusception, bowel infarction, necrosis, stricture, and perforation. We experienced a rare case of HSP-related ileal perforation developed after corticosteroid treatment. We report a case with HSP-related intestinal perforation and assess the effect of corticosteroid on the outcome of abdominal pain in children with HSP.

Allogeneic Peripheral Blood Stem Cell Transplantation in Hematological Malignancies: Stem Cell Mobilization with GM-CSF alone or a combination of GM-CSF and G-CSF from Normal Healthy Donors / 대한혈액학회지

BACKGROUND: Granulocyte-colony stimulating factor (G-CSF) has been used in normal heathy donors to mobilize hematopoietic progenitors. Recently, it was reported that an addition of granulocyte-macrophage-CSF (GM-CSF) mobilized more primitive CD34+ subsets than did G- CSF alone. We investigated the result of the allogeneic peripheral blood stem cell transplantation (PBSCT) with stem cells mobilized with GM-CSF alone or a combination of GM-CSF and G-CSF from normal healthy donors in hematological malignancies. METHODS: Twenty-nine patients with hematologic malignancies had allogeneic PBSCT from normal sibling donors. Nine healthy donors were mobilized with GM-CSF (Leucogen (R)) alone and 20 with a combination of GM-CSF and G-CSF (Leucostim (R)). After 5~8 days of cytokine treatment, PBSCs were collected by large volume leukapheresis and analyzed. RESULTS: Stem cells were collected from the HLA matched normal healthy sibling donors. The mean harvested cell content was 8.74+/-3.22X10(8) MNCs/kg, 15.65+/-16.02X10(6) CD34+ cells/kg of the patients. There were significant differences in the harvested MNC count between mobilization group with GM-CSF alone and group with a bination of GM-CSF and G-CSF. Observed side effects of cytokine mobilization were myalgia (76%), headache (41%), febrile sense (24%) and skin rash (10%). These complications disappeared within 48 hours after discontinuation of cytokines. The median interval to achieve a WBC count>500/uL was 15.00+/-4.23 days, and 14.00+/-33.01 days to a platelet count>20,000/uL. The actual incidence of acute GVHD was 36.4%, 22.7%, and 4.5% for skin, GIT, and liver, respectively. Immunosuppressant responsive chronic GVHD developed in 63.1% (12/19) of assessable patients including 6 cases who had donor lymphocyte infusions. CONCLUSION: In this study, GM-CSF based cytokine mobilization was able to collect sufficient numbers of stem cells and allow rapid engraftment in the allogeneic PBSCT. Mobilization protocol with a combination of GM-CSF and G-CSF seemed to be superior to GM-CSF alone. Acute GVHD in patients with allogeneic PBSCT didn't appear to be more severe than in patients undergoing allogeneic BMT.

Clinical Values of Fine Needle Aspiration Biopsy in Salivary Gland Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diversity of opinion regarding the impact of fine needle aspiration biopsy (FNAB) on clinical decision-making has persisted, mostly because of its high false-negative rate and lower sensitivity in salivary gland diseases when compared to other head and neck tumors. The objectives of this study are to evaluate the utility of FNAB in the diagnosis of salivary gland pathologies and to assess its capacity to provide an accurate medical and surgical treatment. MATERIALS AND METHODS: From June 1989 through January 2000, FNABs were carried out on 50 patients with salivary gland diseases. Among them, 34 patients were confirmed histologically after surgery and others clinically. RESULTS: Regarding the capacity of FNAB to discriminate between neoplastic (malignant and benign) and non-neoplastic lesions, FNAB correctly diagnosed 87% (41/47) of lesions. The values for sensitivity, specificity and accuracy of differentiation for neoplastic lesions were 17%, 95% and 87%, respectively. FNAB's diagnostic accuracy, sensitivity and specificity to Warthin's tumor was higher than to those of pleomorphic adenoma. CONCLUSION: Fine needle aspiration biopsy of salivary gland diseases is a helpful adjunctive test for diagnosis and treatment planning.

A Case of Benign Fibrous Histiocytoma of Frontoethmoid Sinus / 대한이비인후과학회지

Fibrous histiocytoma or other tumors of this group, benign or malignant, usually develop indiscriminately in any skin and soft tissues of the body. Up to the present, tumors occurring in the nasal cavity, paranasal sinuses or nasopharynx have been rarely reported. Most benign fibrous histiocytoma often develop as a painless mass lesion and mostly occur in the-sun-exposed skin and orbital tissue. However, it has also been found in the aerodigestive tract, salivary gland, and deep layers of the scalp and face. The age ranges from 1 to 70 with a male to female ratio of 2.5:1. Recently, we experienced a case of benign fibrous histiocytoma in the frontoethmoid sinus in a 63-year-old woman, whose case was initially considered as a mucocele. The authors believe this is the first reported case of benign fibrous histiocytoma originating in the frontoethmoid sinus.

Standardization of the Nerve Localization Technique in Percutaneous Peripheral Nerve Blockade

OBJECTIVE: We compared a few variables such as the type of needle, the direction of bevel, and the effect of stimulation duration in percutaneous peripheral nerve blockade. We also studied the real distribution of injected drug through nerve biopsy. METHOD: The sciatic nerve-tibialis posterior muscle preparation of rabbit was chosen as a model. Experimental rabbits were divided into 3 groups: Group 1 (16 legs), use of insulated needle and 100 microsecond stimulation duration; Group 2 (9 legs), use of insulated needle and 240 microsecond stimul ation duration; Group 3 (6 legs), use of uninsulated needle and 100 microsecond stimulation duration. The mixed solution, 0.1 cc, of 5% phenol and indian ink was injected in 10 legs and the muscles were obtained to observe the spreads of injected solution after 2 weeks. RESULTS: The minimal stimulation currents of group 1, 2, 3 were 0.49 mA, 0.37 mA, 2.07 mA, respectively. The distance between needle and sciatic nerve sheath of group 1, 2, 3 were 0.09 mm, 0.11 mm, 0.20 mm in width, and 1.84 mm, 3.33 mm, 4.50 mm in depth, respectively. The current required to stimulate the nerve increased rapidly as the tip of the insulated needle passed the nerve, and the direction of bevel had no effect on the minimal stimulation current. Injected indian ink was located alongside the perineurium. CONCLUSION: In three methods, the most exact method was the use of insulated needle and 100s stimulation duration. The needle tip was located 1.84 mm past the nerve.

A Case of Embryonal Rhabdomyosarcoma of Nasal Cavity in Adult / 대한이비인후과학회지

A rare case of the nasal cavity and paranasal sinus is encountered and we report the case with the literature review of embryonal rhabdomyosarcoma. The occurrence of embryonal rhabdomyosarcoma in nasal cavity and paranasal sinus is rather uncommon. Most embryonal rhabdomyosarcoma occurs in children younger than 12 years of age, and in adult, the incidence is only 10%, Recently, we experienced a case of adult embryonal rhabdomyosarcoma originating in the nasal cavity. The clinical course and the possible management of this unusual neoplasm are discussed.

A Retrospective Analysis and Clinical Review of Fistula-in-Ano

PURPOSE: The results for treatment of fistula-in-ano have much improved, along with the development of anatomical knowledge, classification, and operative techniques, during last several decades. The authors retrospectively reviewed the results for treatment of fistula-in-ano, especially complex fistulas, during the last 11 years. METHODS: A retrospective study of fistula-in-ano was performed for 229 patients who had been operated on in St. Benedict Hospital between January 1988 and December 1998. Complex fistulas (IIH, III & IV) were analyzed separately. RESULTS: The most common type was IILs (92 cases, 40.2%), and the most common horseshoe type was IIIBc (5 cases, 2.2%). The average hospital stay was 11.5 days for all fistula-in-ano types, but 15.1 days for complex fistulas. Non-specific inflammation (209 cases, 91.3%) was the most common pathologic finding. Various operative procedures were used : fistulotomy (80 cases, 34.9%), fistulectomy (74 cases, 32.3%), coring out fistulectomy (63 cases, 27.5%), seton technique (11 cases, 4.8%), and muscle-filling technique (1 case, 0.4%). There was no difference in the recurrence rate among the operative types. Various procedures were tried for complex fistulas, but the sphincter-preserving fistulectomy by Takano seemed to have a low recurrence rate and a short postoperative course. However, because of the small number of cases, this difference in recurrence rate and postoperative course was not statistically significant. The overall postoperative complication rate was 7%: anal infection (4 cases, 1.7%), anal bleeding (3 cases, 1.3%), and urinary retention (2 cases, 0.9%). CONCLUSIONS: The operations for most of the fistulae, IH, IL & IIL, were simple and uneventful. However, the operations for complex fistulae were complicated and more skill was required. We have thought Takano's operation to be a good curative procedure with less postoperative deformity and shortened postoperative course. However this research couldn't prove that with statistical significance, probably because of the insufficient number of patients. If further cases are collected and continuous follow-up is done, then a better result can be expected.

Clinical Study of Inguinal Hernia in Children

A total of 335 inguinal hernias in children were analyzed by the authors at the Department of General Surgery, St. Benedict Hospital, for last 10 years, from 1986 to 1995. The male patients were predominant (2.25:1), and 78.2% were under 2 years of age. Right side was 1.63 times more frequent than the left. Among the 19 cases of incarcerated hernias, 84% could be reduced preoperatively in safe. Only 3.6% of the cases were repaired by Bassini procedure, but the others didn't require posterior wall reconstruction. Bilaterality was 25 cases (7.5%), and 8 cases (2.4%) developed later contralateral hernias after primary ipsilateral fix. Complications were in 15 cases (4.5%) such as scrotal seroma and/or hematoma (3%), wound infection (0.6%), pneumonia (0.9%). For the more comprehensive care for the herniated children, specialized practice by a pediatric surgeon would be required in the future.

Lower incisor extraction for dental camouflage / 대한치과교정학회지

There is a variation in the range of normal occlusion, and we must fit our treatment to the needs of each patient. If the upper or lower incisors are congenitally missing, malformed, or crowded, the extraction of the incisor has some advantages over the extraction of premolars and nonextractions. The advantages are l) simple mechanics, 2) reduced treatment time, 3) less relapse tendency, and 4) fewer facial profile changes. In order to decide which incisor should be extracted, we must consider certain factors: l) discrepancies in anterior arch length, 2) anterior tooth ratio, 3) periodontal and tooth health condition, and 4) the relationship between the upper and lower midline. Diagnostic set-up can be helpful to plan the treatment and show us the post treatment result.