Outcomes of Surgical Management of Xanthelasma Palpebrarum

BACKGROUND: Xanthelasma palpebrarum (XP) is a benign disorder manifesting as yellowish cholesterol-laden plaques on the eyelids. This paper presents the outcomes in patients with XP who have undergone surgical excision as the main modality of treatment. METHODS: A retrospective review of patients who received surgery for xanthelasma palpebrarum from March 2007 to March 2011 was conducted. Patients were classified into four grades according to the location and extent of the lesion, with grade I being the mildest and grade IV being the most diffuse. Simple excision was performed in grade I and II lesions, while local flaps and skin grafts were performed in the more advanced grades. RESULTS: Ninety-five cases from March 2007 to March 2011 were included in this study. 66 cases (70%), were treated by simple excision. Twenty-four cases (25%) and 5 cases (5%) were treated by simple excision in combination with or without local flaps and skin grafts. In approximately 1/4 of the patients, orbicularis oris muscle involvement was observed. 4 patients (4.2%) developed scar contracture postoperatively, which required a secondary procedure. Recurrence was reported in 3 patients (3.1%). Otherwise. There were no other reports of major complications or disfigurement. CONCLUSIONS: We found that for lesions involving the deep dermis and/or muscle, surgical excision was the most appropriate therapeutic option.

Closed Reduction of Zygomatic Arch Fracture with Intraoperative Mobile Computed Tomography Scan

PURPOSE: The purpose of this study is to describe the usefulness of intraoperative mobile CT scans in the reduction of zygomatic arch fracture. Method: Two patients with zygomatic arch fractures were selected who were indications of closed reduction by Gilles' approach. After the reduction was done in the operating room with zygomatic arch elevator, intraoperative CT scan was done to check the extent of reduction. Additional reduction was performed according to the obtained images from the intraoperative mobile CT scan. Examination of the preoperative CT, intraoperative CT after the reduction, and postoperative plain X-ray films were done for documentation and analysis. RESULTS: Reduction was carried out successfully to the patients without any complications. Both patients were satisfied with the postoperative cosmetic and functional outcome. Revisional surgery was not necessary during the 6 months follow up. CONCLUSION: The advantage of this method is that it is easier to obtain three dimensional relationships of the fracture site. Furthermore, the operator is less exposed to radiation hazards compared to other methods that obtain intraoperative images such as the C-arm. In conclusion, intraoperative mobile CT scan can be a useful surgical aid in the reduction of zygomatic arch fractures.

Clinical Features of Isolated Noncompaction of the Ventricular Myocardium

PURPOSE: Isolated noncompaction of the ventricular myocardium(INVM) is one of the unclassified cardiomyopathies that is characterized by numerous, excessively prominent trabeculations, and deep intertrabecular recesses. We performed this study to evaluate the clinical features of INVM in children. METHODS: The medical records of 10 patients with INVM were reviewed. We analyzed the clinical manifestations, hemodynamics, pattern of inheritance, and long-term prognosis of INVM in children. RESULTS: Age at diagnosis was 45+/-53 months(1 day-14 years) with follow-up lasting as long as 78 months. Most INVM was asymptomatic on diagnosis. Associated cardiac anomalies were noted in six patients(ventricualr or atrial septal defect, patent ductus arteriosus with mitral valve prolapse, or mitral valve cleft). Depressed or flat changes of T wave in lead II, III and aVF were observed on electrocardiography. Various arrhythmia including WPW syndrome with paroxysmal, supraventricular tachycardia, third-degree atrioventricular block, and familial sick sinus node dysfuction were observed. The degree of trabeculation in INVM was significantly prominent from level of mitral valve to apex compared to age-matched control. Familial recurrences were noted in two patients. The systolic function of the left ventricle was decreased in 20% of patients during the follow-up period, but systemic embolism or ventricular tachycardia was not observed. CONCLUSIONS: INVM is not a rare disorder. The cardiac function may be deteriorated in children as well as adults during long-term follow up. Thus early diagnosis and long-term follow-up must be done. So, the nation-wide multicenter clinical study would be mandatory to evaluate the incidence, long-term prognosis, and establishment of objective diagnostic criteria of INVM.

Appraisal of Histamine Concentration on Skin Reactivity in Infancy / 소아알레르기및호흡기학회지

PURPOSE: It is well known that the histamine test is essential for positive control in the evaluation of allergy skin test. Estimation of the allergen wheal size without histamine control may be affected by child growth and observer's subjective factos. The skin test reactivity to histamine in infancy is weak and difficult to be used as be positived control. This study is to define the status of skin test reactivity to histamine, and any difference of reactivity between various concentrations of histamine in infancy. METHODS: The 241 babies including normal infants and prematurity in pediatric department of Chungnam National University Hospital from January 2001 to May 2001 were selected and divided into 5 groups by age. Three different Concentrations of histamine of 1, 5, and 10 mg/mL were injected on left forearm by prick procedure respectively. The differences of wheal size by age groups and concentrations of histamine were analyzed. RESULTS: No reaction was predominant in prematurity, weak reaction in birth to 6 months of age, and strong reaction in above 6 months of age. In the skin test reactivity by histamine concentrations, there was no difference of no reaction histamine concentrion of 1 and 5 mg.mL. But rate of no reaction to histamin was significantly lower in the concentration of 10 mg/mL. There was no difference for the rate of week reaction to histamine by histamine concentration. There were significant differences between concentrations of histamine, especially more in 10 mg/mL concentration for strong reaction. CONCLUSION: The skin test reactivity to standard histamine were weak in entire period of infancy, especially in under 6 months of age including prematurity. However, the reactivity to 10 mg/mL conc. of histamine were increased in all infants and different definitely in degree. It was suggested that 10 mg/mL of histamine concentration was more useful for positive control than standard histamine in infancy.