Sequencing of panfacial fracture surgery: a literature review and personal preference

Background@#Treating panfacial fractures (PFFs) can be extremely difficult even for experienced surgeons. Although several authors have attempted to systemize the surgical approach, performing surgery by applying a unidirectional sequence is much more difficult in practice. The purpose of this study was to review the literature on PFF surgery sequence and to understand how different surgical specialists–plastic reconstructive surgery (PRS) and oral maxillofacial surgery (OMS)–chose sequence and review PFFs fixation sequence in clinical cases. @*Methods@#The PubMed and Google Scholar databases were scoured for publications published up until May 2020. Data extracted from the studies using standard templates included fracture part, fixation sequence, originating specialist, and the countries. Bibliographic details like author and year of publication were also extracted. Also, we reviewed the data for PFFs patients in the Trauma Registry System of Dankook University Hospital from 2011 to 2021. @*Results@#In total, 240 articles were identified. This study comprised 22 studies after screening and full-text analysis. Sixteen studies (12 OMS specialists and 4 PRS specialists) used a “bottom-top” approach, whereas three studies (1 OMS specialist and 2 PRS specialists) used a “top-bottom” method. However, three studies (only OMS specialists) reported on both sequences. In our hospital, there were a total of 124 patients with PFF who were treated during 2011 to 2021; 64 (51.6%) were in upper-middle parts, 52 (41.9%) were in mid-lower parts, and eight (6.5%) were in three parts. @*Conclusion@#Bottom-top sequencing was mainly used in OMS specialists, and top-bottom sequencing was used at a similar rate by two specialists in literature review. In our experience, however, it was hard to consistently implement unidirectional sequence suggested by a literature review. We realigned the reliable and stable buttresses first with tailoring individually for each patient, rather than proceeding in the unidirectional sequence like bottom-top or top-bottom.

The Emergency Care Experience and Demand for Support of School Nurse

PURPOSE: This study explores school nurses' emergency care experiences and their needs for systemic institutional support. METHODS: Data were collected in 2016 from the interviews with five focus groups comprising thirty school nurses. Qualitative content analysis was then performed using the collected data. RESULTS: The study found that school nurses were vulnerable to over-reaction in uncertain situations as the school's sole health service provider. The study's findings are divided into ten categories. 1) Major obstacles to overcome as the sole health service provider, 2) Assessing an uncertain situation and making appropriate decisions, 3) Providing limited first aid while maintaining control over the situation, 4) Referring or transferring a student to a hospital that creates tensions and raises cost, 5) Becoming an advocate for information disclosure and treatment, 6) Ensuring follow-up actions and proper transfer of responsibility, 7) Making preparations for future emergency, 8) Responding to conflicts arising from over-reaction as a safeguard and professional expertise, 9) Need for the development of standardized manual for school emergency care, 10) Need for practical case-based training. CONCLUSION: The findings of this study should contribute to the development of the programs aimed at improving school emergency care and the professional competence of school nurse.

Balo's Concentric Sclerosis in a Patient with Previous Recurrent Optic Neuritis

Balo's concentric sclerosis is regarded as a rare variant of multiple sclerosis. Traditionally, Balo's concentric sclerosis was a post-mortem diagnosis, but the recent introduction of brain magnetic resonance imaging (MRI) scans may allow noninvasive access without biopsy. Brain MRI findings of Balo's concentric sclerosis is characteristic concentric configuration of alternating bands of white matter of different pathology, with relatively preserved myelination alternating with regions of demyelination in the cerebral white matter. We report a case of Balo's concentric sclerosis with recurrent optic neuritis.

Seoul Teacher's Satisfaction with and Needs for Health Examination and Health Promotion Programs

PURPOSE: The purpose of this study was to investigate Seoul teacher's satisfaction with and needs for health examination and health promotion programs. METHODS: The participants were 3,186 teachers in Seoul. Data were collected through an on-line survey system from November 16 to December 7, 2008. Collected data were analyzed by descriptive statistics, t-test, ANOVA, and Scheffe's test using PASW 18.0 program. RESULTS: Teacher's satisfaction with teacher health examination was low and needs for detailed tests of cancer and vocal cord disorders were high. Teacher's satisfaction with teacher health promotion programs was low and needs for stress management, exercise and vocal cord protection program were high. CONCLUSION: Vocal cord disorders should be included in teacher health examination and vocal cord protection program should be provided for teacher's health promotion. Stress management and exercise program should also be provided for teacher's health promotion.

Clinical Evaluation and Treatment of Unexpected Invasive Cervical Cancer Found at Simple Hysterectomy / 대한산부인과학회지

OBJECTIVE: The objective of this study was to analyze the clinical aspects, the problems in diagnstic process, proper complimentary treatment of invasive cervical cancer found after simple hysterectomy. METHODS: From February 1990 till December 2003, of the 2013 patients who underwent simple hysterectomy at Departments of Obstetrics and Gynecology, College of Medicine, Kyung Hee University, 4 cases who were able to be followed up with the pathological diagnosis of invasive cervical cancer, were picked. One patient transferred to KHMC of a recurrence at the vaginal stump after vaginal hysterectomy performed at a nearby clinic was chosen. The archives of the 5 patients were analyzed. RESULTS: Of the 5 cases, 2 were treated with whole-pelvis external radiation for 6 weeks. The follow-up periods after radiotherapy were after 5 months and 48 months, and they are both disease-free and are in satisfactory health conditions. The patients who underwent simple hysterectomy and received re-operations, one case after one month, and the other after 2 months in case 2 and 3, showed negative results in the biopsy and the follow-up periods after the operation were 12 months and 42 months, maintaining healthy conditions. The patient in case 5 who received pelvic exenteration after additional staging operations and 7 cycles of chemotherapy done after whole-pelvis external radiation/intracavitary radiotherapy for 6 weeks after simple hysterectomy, showed negative biopsy results and is currently being followed up at the outpatient clinic. CONCLUSION: To prevent for invasive cervical cancer diagnosed pathologically after simple hysterectomy, a variety of complimentary tests should be performed and thorough step-by-step pre-operative exams should be emphasized as in the well-established diagnostic guidelines. Invasive lesions as more than post-operative stage Ia2 found after simple hysterectomy need much more aggressive supportive treatment. But between pelvic irradiation and secondary radical re-operation, which treatment is advisable is not yet concluded. Therefore, the treatment should be chosen case-by-case according to the patient's condition.

A Case of Endometrial Cancer with Hereditary Non-Polyposis Colorectal Cancer (HNPCC) / 대한산부인과학회지

Endometrial cancer is the most common malignant disorder that can be associated with hereditary non-polyposis colorectal cancer (HNPCC), which is known as Lynch II syndrome. HNPCC is a polyposis of the colon which is inherited in an autosomal dominant pattern and can cause cancer in other organs, especially in the endometrium. The overall risk of a women with HNPCC to develop endometrial cancer is 40-60%, much higher than the 3% of the general population of women. The average age of developing endometrial cancer of a women with HNPCC is 45 years of age and is often found before development of colon cancer. We have recently experienced a case of de novo type of hereditary non-polyposis colorectal cancer associated with endometrial cancer, hence we are reporting this case with a brief review of literatures.

A Case of Prenatally Diagnosed Jacobsen syndrome / 대한산부인과학회지

Jacobsen syndrome is a rare condition associated with the deletion of the long arm of chromosome 11. Though several authors reported prenatal sonographic findings of the Jacobsen syndrome, there are no common disease-specific features. The majority of affected cases were identified postnatally by chromosomal analysis of the dysmorphic or mentally retarded patients. We present a prenatal case of Jacobsen syndrome with a brief review of literature. A routine scanning in a 32-year-old primigravida at 17.3 weeks' gestation showed abnormal ultrasonographic findings consistent with increased nuchal thickening and subtle cardiac abnormalities (levorotated heart axis of greater than 60 degrees and thickened ventricular wall). The patient underwent amniocentesis, and the karyotype showed deletion of the long arm of chromosome 11, 46,XX, del (11) (q23.1q24). The fetal autopsy performed following medical termination confirmed the prenatal findings. The present case represents that the prenatal sonographic detection of the nuchal thickening and subtle cardiac abnormality should warrant a careful assessment of fetal anatomy and prompt cytogenetic analysis looking for chromosomal aberrations.

Thymidine Phosphorylase Expression in Progression of Cervical Lesions: Histological Features and Microvessel Density / 대한산부인과학회지

OBJECTIVE: The object of this study was to clarify the association of thymidine phosphorylase (TP) assessed in cancer cells and in stromal cells, with clinico-pathological factors including tumor angiogenesis and prognosis in cervical cancer. METHODS: From January 1999 to December 2001, 45 cervical tissue specimens were obtained by surgical resection in the Kyung Hee University Medical Center. The study group included 25 cases in invasive squamous cell carcinomas (SCC), 9 cases in carcinoma in situ (CIS), 7 cases in microinvasive carcinoma, 4 cases in the benign uterine diseases. They were analyzed for the cellular expression of TP and the intratumoral density of microvessels by immunohistochemistry using monoclonal antibodies to TP and factor VIII related antigen, respectively. RESULTS: Our data showed that TP expression and MVC (microvessel count) increased with histologic stage from normal, through CIS to SCC, respectively. The manifestaion of TP in the epithelium and the stroma is closely related with angiogenesis. Intraepithelial tumor revealed high expression rate of TP in the stroma, invasive cervical cancer in the epithelium, microinvasive cancer in the stroma and epithelium showing different areas of manifestation for each histologic condition, but did not show a statistically significant difference. In the case of cervical cancer, the more progressive the cancer, angiogenesis and the expression of TP increased significantly. Especially in the case of invasive cancer, stromal TP expression rate was high. CONCLUSION: These results suggest that thymidine phosphorylase might play an important role in angiogenesis, involving? cooperative epithelial and stromal expression of enzyme. Thymidine phosphorylase thus could be useful for a marker in assessing the survival rate in patients with cervical cancer.

A Case of Adenocarcinoma Arising from Dermoid Cyst of the Ovary / 대한산부인과학회잡지

The ovarian dermoid cyst is the most common ovarian neoplasm in young women and comprises approximately 10-20% of all ovarian tumors. But malignant transformation is an uncommon complication in an ovarian dermoid cyst, usually being reported in about 1.0-1.8% of cases. Most common malignant transformation of ovarian dermoid cyst is squamous cell carcinoma, which represents about 75-80% followed by adenocarcinoma in 6-7%. We report a case of adenocarcinoma arising from ovarian dermoid cyst with a brief review of literatures.

A Case of Primary Adrenal Gland Lymphoma

Primary adrenal lymphoma is extremely rare. We describe a case of non-Hodgkin's lymphoma of diffuse large B-cell type with right adrenal involvement. The patient received chemotherapy and external irradiation and achieved complete remission of the disease. We describe the case of primary adrenal lymphoma with a review of the literature on this unusual neoplasm. Primary adrenal lymphoma should be included in the differential diagnosis of adrenal mass.