Management of Le Fort I fracture

Among the classification of maxillary fracture, the Le Fort classification is the best-known categorization. Le Fort (1901) completed experiments that determined the maxilla areas of structural weakness which he designated as the “lines of weakness”. According to these results, there are three basic fracture line patterns (transverse, pyramidal and craniofacial disjunction). A transverse fracture is a Le Fort I fracture that is above the level of the apices of the maxillary teeth section, including the entire alveolar process of the maxilla, vault of the palate and inferior ends of the pterygoid processes in a single block from the upper craniofacial skeleton. Le Fort fractures result in both a cosmetic and a functional deficit if treated inappropriately. In this article, authors review the management of a Le Fort I fracture with a case-based discussion.

Sensory Impairment in Infraorbital Nerve Following Mid-Facial Fractures

PURPOSE: Sensory impairment in infraorbital nerve is common symptom following mid-facial fractures. The purpose of this study is to document the incidence of sensory impairment in infraorbital nerve following mid-facial fractures and its recovery. METHODS: Three hundreds fourteen patients with mid-facial fracture were included involving emergence areas of infraorbital nerve. Fractures were classified into zygoma fracture, maxilla fracture, complex comminuted fracture and pure blow out fracture. Neurosensory function was assessed with clinical symptoms and light touch test in infraorbital nerve regions. Patients were followed and sensory function was evaluated immediately, 1, 3 and 6 months after trauma. RESULTS: The total series consisted of 198 zygoma fractures, 19 maxilla fractures, 30 complex comminuted fractures and 67 pure blow out fractures. The incidence of sensory impairment was 60% (63% in zygoma fractures, 84% in maxilla fractures, 93% in complex comminuted fractures, 31% in pure blow out fractures). Persistent sensory impairments were remained in 32% (33% in zygoma fractures, 47% in maxilla fractures, 73% in complex comminuted fractures, 6% in pure blow out fractures) 6 months after trauma. Younger patients had better prognosis than older patients in recovery of infraorbital nerve function(p<0.05, chi2-test). Mean recovery time was 11 weeks. CONCLUSION: The incidence of post-traumatic sensory impairment was different according to fracture types. Age of patients and fracture type were important factors that influence to recovery of sensory impairment. Complex comminuted fracture had poor prognosis, and pure blow out fractures had better prognosis than other fractures.

Primary Cleft Lip Repair Using the "Delaire" Technique

Deformities related with cleft lip are not only limited to the cleft site but also extended to all around the nasolabial region. Facial development is composed of several complex processes as the formation, migration, coalescence and interaction of separate fields. When there is a cleft event, it means there are general problems of those processes. As a result facial elements should have displacement, deformation and functional hypotrophy. These also affect the mucocutaneous structures, which result in the typical deformities of cleft lip. Traditional surgical methods are not sufficient of the correction of functional impairments in the cleft lip. Accordingly, there are relatively high possibilities of occurring secondary deformities. The Delaire's method focuses on repair of functional impairment of the cleft. Consequently, it can maintain the initial good surgical result and avoid the unnecessary incision scar. And this method can minimize secondary nasal deformities which can reduce the risk of additional nasal correction. Therefore authors introduce this advantageous the Delaire technique cheliolplasty which it can be widely used for the cleft lip correction in Korea.

Three Rotational Variables in Osseous Genioplasty

PURPOSE: Chin is located in a prominent position, and is important to balance and harmony of the face. Genioplasty is widely performed with patients' high satisfaction, yet being relatively simple procedure. Recently in analysis of dentofacial trait, three rotational variables of yaw, pith, and roll are considered with three translational variables(forward/backward, up/down, right/left). And we could correct chin deformity effectively by applying the three rotational variables with three translational variables in genioplasty. METHODS: Twenty-eight patients who have chin deformity underwent osseous genioplasty. Preoperative photography, facial three dimensional computed tomography, and cephalography were taken while chin deformities were accessed. The chin deformity was classified into four categories; macrogenia, microgenia, asymmetric chin deformity, and combined chin deformity groups. According to the nature of chin deformities and the patients' desire, preoperative plans were formulated, in consideration of three rotational variables and translational variables. Through intraoral approach, anterior mandible was exposed in the subperiosteal plane between the mental foramens and beneath the mental foramens. In the anterior mandible, vertical and horizontal grid lines with 5mm intervals were marked to confirm the spatial location of osteomized bone segment after osteotomy. Chin repositioning was done in consideration of axial rotation and planar translation. RESULTS: Most of the patients had achieved satisfactory results with few complications. By considering the three rotational variables, it was possible to make the chin repositioning effectively. One of the patients complained about insufficient chin correction. In other case, persistent sensory impairment around chin was observed. CONCLUSION: In conclusion, it is worthwhile to apply preoperative analysis and operative procedures in consideration of a three rotational variables with three translational variables in genioplasty.

Taxonomic Studies on the Genus Marssonina in Korea

Eight species of Marssonina parasitic on 21 species of host plants from Korea are described and illustrated. They are Marssonina brunnea (Ellis & Everh.) Magnus, M. capsulicola (Rostr.) Magnus, M. celastri H.D. Shin & H.T. Lee, M. coronaria (Ellis & Davis) Davis, M. fragariae (Lib.) Kleb., M. juglandis (Lib.) Magnus, M. rosae (Lib.) Died. and M. sennenis (Gonz. Frag.) Vassiljevsky & Karak. Of these, M. capsulicola and M. coronaria sometimes poss three-celled conidia and M. sennenis is characterized by a short appendage at the basal end of the conidia. Morphological features of conidia and host ranges were of taxonomic values for species delimitation.

A Study on the Role of Bacteria in the Pathogenesis of Confluent and Reticulated Papillomatosis / 대한피부과학회지

BACKGROUND: The pathogenesis of confluent and reticulated papillomatosis(CRP) is still unknown, although many theories have been suggested. It is stressed that abnormal host response to colonization of pityrosporum orbiculare might play a role in the pathogenesis of CRP, but is not completely understood. Frequently, we have observed bacterial colonies in the stratum corneum and, especially, within the hair follicles from biopsy specimens of patients with CRP. In addition, successful treatment for CRP with minocycline, a derivative of tetracyclines, has been reported continuously. OBJECTIVE: The purpose of this study was to document the possible association of bacterial factors in the pathogenesis of CRP and to elucidate the effectiveness of minocycline. METHODS: We performed Brown and Brenn gram staining in 12 biopsy specimens, bacterial cultures, identification of microorganisms and antibiotics sensitivity testing including minocycline. We administered oral minocycline with an initial dose of 100mg per day for 1 to 3 months and a maintenance dose 50mg per day for I to 2 months, then evaluated the response of treatment. RESULTS: 1. On Brown and Brenn staining, the gram positive bacterial colonies that stained dark bluish or nearly black were observed within the infundibulum of hair follicles in 10 out of 12 biopsy specimens(83.3%) and on the keratotic invagination of stratum corneum in 11 out of 12 biopsy specimens(91.7%). 2. Histological features of regions where bacterial colonies were observed showed, hyperkeratosis and keratotic invagination on the stratum corneum in all cases. Hyperkeratosis(66.7%), parakeratosis(16.7%), inflammatory cell infiltration(25.0%), perifollicular fibrosis(33.3%), and abnormal keratin in sebaceous ducts(50.0%) were shown in hair follicles. 3. In anaerobic cultures, no bacteria was grown. In aerobic cultures, staphylococcus species were identified in 6 cases, streptococcus viridans in one case, sternotrophomonas maltophilia in one case. In the susceptibiliity test, minocycline was sensitive in 7 from 8 cases. 4. The therapeutic response to minocycline was observed within one month in all cases, and the time to clear the lesions was 1/2 month in 2 cases, 1 month in 4 cases, 2 months in 5 cases, 3 months in one case, respectively. CONCLUSION: Form these results, we suggest that bacterial factors may play an important role in the pathogenesis of CRP and that the action mechanism of minocycline in the treatment of CRP may be due to antibacterial effects.

Immunohistochemical Study on Expression of Transforming Growth Factor-betas in Keratoacanthoma and Squamous Cell Carcinoma / 대한피부과학회지

BACKGROUND: Because of the clinical and histological similarities of keratoacanthoma(KA) and squamous cell carcinoma(SCC), it is often difficult to differentiate. Transforming growth factor-betas (TGF-betas) are the multifunctional peptides that regulate the cellular growth and differentiation. It has been known that the isoforms of TGF-beta(TGF-beta1, TGF-beta2, TGF-beta3) are differently expressed in human cancers such as basal cell carcinoma, pancreatic cancer, thyroid cancer, etc. OBJECTIVE: The purpose of this study was to examine the expression patterns of TGF-beta isoforms on KA and SCC using the immunohistochemical staining method with anti-TGF-betas antibodies and to evaluate the usefulness of this method in distinguishing each other. METHODS: We performed immunoperoxidase staining(LSAB technique) using polyclonal anti-TGF-beta1, b2, and b3 antibodies from the formalin-fixed, paraffin-embedded biopsy specimens obtained from 11 patients with KA, 11 pntients with SCC, and 10 healthy volunteers. RESULTS: In the normal skins, TGF-beta1, b2 and b3 were almost negative or only weakly positive in the epidermis, whereas TGF-beta3 was moderately to strongly positive in the suprabasal layer. In KAs, the expression patterns of TGF-beta1, b2, and b3 were similar to those of the normal skins. In SCCs, however, the expression of TGF-beta1 was increased and TGF-beta3 was decreased compared with the normal skins. CONCLUSION: In these results, the immunohistochemical staining using the anti-TGF-betas antibodies, especially anti-TGF-beta1 and b3, can be used for the differentiation of KA and SCC. Also, it can be suggested that the charige of expressions of TGF-beta isoforms in the epidermis may play an important role in the carcinogenesis of SCC.

A Case of Multiple Sebaceous Carcinomas on the Frontal Region / 대한피부과학회지

Sebaceous carcinoma is a rare, aggressive, malignant tumor derived from the adnexal epithelium of sebaceous glands. This tumor occurs most frequently on the eyelids, but may occur on the extraoccular sites. Clinically, it is presented as a solitary tumor in most cases and very rarely as multiple ones. We report a case of multiple. sebaceous carcinomas on the frontal region in a 73 year-old man. He had well-demarcated, reddish, asymptomatical, protruding masses on the frontal region for 2 months. The histopathologic findings showed irregular, variable sized, lobular tumor nests of the entire dermis, and each lobule was composed of foamy cytoplasmic atypical cells and undifferentiated cells containing, eosinophilic cytoplasm. He was treated with surgical excision and no recurrence was observed during 6 months.

A Case of Idiopathic CD4 + T Lymphocytopenia Associated with Kaposi's Sarcoma / 대한피부과학회지

Idiopathic CD4+ T lymphocytopenia (ICL) is a new disease entity characterized by depletion of helper T cells apparently without any evidence of HIV infection. We report a case of ICL associated with Kaposis sarcoma (KS) and pneumocystis carinii pneumonia (PCP) in a 34-year old woman. She developed violaceous, protruding masses on scalp, back, both extremities, palms, soles, left. first toe and peritonsillar region for 2 months. These lesions were confirmed as KS by histopathologic findings. Chest X-ray and HRCT findings represented PCP and KS. Absolute deficiency of CD4+ T cell was detected in the count of T cell subsets. Serologic tests for HIV-1, 2 and HTLV I, -II were negative. And she was absent any defined immunodeficiency or therapy associated with decreased levels of CD4+ T cells. By CDC criteria, a diagnosis of ICL was made. Because of aggravation of PCP and lung involuement of KS, she died at 22nd day after admission.

A Clinical and Histopathological Study of Xanthomas / 대한피부과학회지

BACKGROUND: Xanthomas consist of localized infiltrates af lipid-containing histiocytic foam cells that are usually found within the dermis or tendons. They frequently arise in the presence of a disturbance of lipid metaholism. OBJECTIVE: The purpose of this study was to elucidate the clinical and histopathological characteristics of xanthomas. METHODS: Eighteen cases of xanthoma confirmed clinically and histopathologically were ana lyzed. Xanthelasma was excluded in this study. RESULTS: The results were summarized as follows. 1. The incidence of xanthoma was 0.03% of the total number of dermatologic patients. 2. The ratio between male and female was 1:2.6 and the age distribution varied from 2 to 65 years old(mean age : 37.4 years-old), and the distribution of age of onset was from birth to 62 years old(mean age of onset: 32.9 years old). 3. The frequencies of elinical types, in descending order, were xanthoma tuberosum(XT) 44.4%, xanthoma planum(XP) 27.8%, Xanthoma eruptivum(XE) 22.2%, and xanthoma striatum palmare (XSF) 5.6 %. 4. The common sites were the knee, elbow and buttock in XT; The upper and lower extremities in XE, the cheek, neck and chest in XP; palmar creases in XSP. 5. Serum lipid abnormalities were detected in 88.9%(16/18). 6. The associated diseases were hypothyroidism, diabetes, hepatomegaly, psoriasis. 7. A family history was significant in 2 patients with XT. 8. The associated hyperlipoproteinemia was type IIa(4/8), IIb(2/8), III(1/8), IV(1/8) in XT, type IIa(2/5), IV(2/5) and normolipoproteinemia(1/5) in XP, type I(1/4), IV(1/4), V(1/4) and normolipoproteinmia(1/4) in XE, type III(1/1) in XSP, respectively. 9. Diet, alone or combination with antilipidemic drugs were used for treatment, and the lesions were cleared in 2(one XP and one XE) of 7 patients that could be followed up. 10. Histopathological features revealed that lipid-laden foamy histiocytes were observed in all cases of xanthomas and foreign body giant cells were more common than Touton giant cells. CONCLUSION: Xanthomas were not so common disorders compared with the incidence of hyperlipoproteinemia and were more common in females than males. The most common clinical type was XT except for xanthelasma. The most common associated hyperlipoproteinemia in each type of xanthoma was type II in XT, type IIa and IV in XP, variable types in XE, type III in XSP, respectively. Lipid-laden foamy histiocytes were observed in all cases of xanthomas and for eign body giant cells were more common than Touton giant cells.

Clinical Efficacy and Tolerability of Terbinafine 1% Cream in Patients with Pityriasis Versicolor

No abstract available.

Simple Unilateral Ectopic Kidney / 대한비뇨기과학회지

Two cases of ectopic kidney were reported in conjunction with review of literatures. The ectopic kidneys, measuring 13 cm-,15 cm in length of their ureter, were located between the L3 .and S1. Operative removal of the ectopic kidney disclosed aberrant arteries in their both pole. histological examination revealed normal findings.

Klinefelter's Syndrome / 대한비뇨기과학회지

A study was made on the two cases of Klinefelter's Syndrome with review of literatures Two cases revealed findings characteristic of Klinefelter's Syndrome suck as small testes, hyalinization of seminiferous tubules. azoospermia, increased urinary gonadotropin, decreased urinary 17-ketosteroid, positive sex chromatin, gynecomastia and impotence.