The Comparison of Punctoplasty and Silicone Tube Intubation in Patients with Punctal Obstruction

PURPOSE: To compare surgical results of two patient groups with punctal obstruction. One group underwent punctoplasty while the other group underwent silicone tube intubation. METHODS: We compared postoperatively 48 eyes of 37 patients with punctal obstruction within and after one year of the procedure. 24 eyes of 17 patients had punctoplasty and 24 eyes of 20 patients had silicone tube intubation by the same surgeon. RESULTS: Upon follow-up within one year after the punctoplasty, 13 eyes (54%) showed no epiphora, nine eyes (38%) showed intermittent epiphora, and two eyes (8%) showed persistent epiphora. However, after silicone tube intubation, 20 eyes (83%) showed no epiphora, three eyes (13%) showed intermittent epiphora, and one eye (4%) showed persistent epiphora. Over one year after the punctoplasty, one eye (4%) showed no epiphora, 19 eyes (78%) showed intermittent epiphora, and four eyes (17%) showed persistent epiphora. However, after the silicone tube intubation, 17 eyes (71%) showed no epiphora, six eyes (25%) showed intermittent epiphora, and one eye (4%) showed persistent epiphora. CONCLUSIONS: Silicone tube intubation is more effective than punctoplasty in the long term treatment of punctal obstruction.

Different Effect of IVTA in the Management of Macular Edema Secondary to Perfusion and Ischemic Type BRVO

PURPOSE: To investigate the improvement of visual acuity with the different effects of ischemic and perfusion type branched retinal vein occlusion (BRVO), and explore the relationship between defects of the macular capillary network and intravitreal injection of triamcinolone acetonide (IVTA) for treatment of BRVO secondary to macular edema. METHODS: We compared macular capillary network condition, improvement of visual acuity due to ischemic range, and decrease of macular edema between 23 perfusion type BRVO patients and 21 ischemic type BRVO patients who were treated with IVTA for BRVO secondary to macular edema. RESULTS: Both ischemic and perfusion type BRVO exhibited decreased macular edema and showed meaningful improvements in visual acuity (P<0.01), but did not show a relationship between the defects in the macular capillary network and improvement of visual acuity. No differences were seen in macular capillary network defects between ischemic and perfusion type BRVO. CONCLUSIONS: IVTA had an effect on the decrease in macular edema and improvement of visual acuity for both ischemic and perfusion type BRVO. However, defects in the macular capillary network do not seem to have any effect on the improvement of visual acuity.

The Usefulness of Costochondral Cantilever Graft for Correction of Saddle Nose

PURPOSE: Saddle nose deformity results from lack of support to the nasal dorsum. The integrity of both the cartilaginous or bony portion of the nose is compromised. Cantilever bone graft is the mainstay for correction of saddle nose deformity, but the problems of bone graft are stiffness of the nasal tip and resorption. Thus the authors propose a costochondral cantilever graft, with the bony and cartilaginous portion harvested as one block, using cartilaginous portion as support to the nasal tip. METHODS: Between October of 1996 and July of 2005, 8 cases of saddle nose deformity were treated by the same surgeon. All patients had undergone costochondral cantilever graft. Postoperative evaluation included the depression of the nasal dorsum and tip. Comparisons of preoperative and postoperative photographs was done if possible. RESULTS: The mean follow-up period was 5.9 years. The results were excellent aesthetically and there was no complication. Conclusion: The authors' method maximize the benefits of each bone and cartilage graft while minimizing their inherent limitations.

Clinical Experience of Pulmonary Embolism after Coverage of Pressure Sore

Pulmonary embolism is a one of the major cause of postoperative death. Surgery predisposes patients to pulmonary embolism, even as late as one month after the operation. The accurate detection of pulmonary embolism remains difficult, and the differential diagnosis is extensive. The prevention of pulmonary embolism is thus of paramount importance. We report a case of pulmonary embolism after coverage of pressure sore on the left ischium on the 8th day after operation. The patient was 60 years old, a severe smoker, in the high quantity of body mass index and had hypertension. The risk factors are 60 years of age or older who were in the highest quantity of body mass index. Heavy cigarette smoking and high blood pressure are also identified as risk factors. Plastic surgeons should keep the probability of pulmonary embolism development after operation in mind. When taking history, the risk factors should be checked certainly. The immobilization may explain the probability of pulmonary embolism development. Therefore absolute bed rest or positional maintenance should be avoided. Until recently, low molecular weight heparin has been used for preoperative prophylaxis. Plastic surgeons should be concerned in low molecular weight heparin for prophylaxis of the pulmonary embolism and study the indications and effectiveness in liposuction or abdominoplasty.

The Effects of Various Extracellular Matrices on Motility of Cultured MC3T3-E1 Cell

Chemotactic migration of bone forming cell, osteoblast, is an important event during bone formation, bone remodeling, and fracture healing. Migration of cells is mediated by adhesion receptors, such as integrins, that link the cell to extracellular matrix ligands, type I collagen, fibronectin, laminin and depend on interaction between integrin and extracellular ligand. Our study was designed to investigate the effect of extracellular matrix like fibronectin, laminin, type I collagen on migration of osteoblast. Migration distance and speed of MC3T3-E1 cell on extracellular matrix-coated glass were measured for 24 hours using 0.01% type I collagen, 0.01% fibronectin, 100 microliter/ml laminin. The migration distance and speed of MC3T3-E1 cell was compared using a video-microscopy system. To determine migration speed, cells were viewed with a 4 phase- contrast lens and video recorded. Images were captured using a color CCD camera and saved in 8-bit full-color mode. The migration distance on 0.01% type I collagen or 0.01% fibronectin was longer than that on 100microliter/ml laminin-coated glass. The migration speed on fibronectin-coated glass was 68 micrometer/hour which was fastest. The migration speed on type I collagen-coated glass was similar with that on fibronectin-coated glass. The latter two migration speeds were faster than that on no-coated glass. On the other hand, the average migration speed on laminin-coated glass was 37micrometer/hour and not different from that of control group. In conclusion, the extracelluar matrix ligands such as type I collagen and fibronectin seem to play an important role in cell migration. The type I collagen or fibronectin coated scaffold is more effective for migration of osteoblast in tissue engineering process.

Nasal Deformity and Acoustic Airway Obstruction Profiles in Unilateral Secondary Cleft Lip Nose Deformity

Patients with secondary cleft lip nose deformity usually complain not only aesthetic problems but also functional problems such as nasal obstruction. However, there have been few studies on nasal airway problem in secondary cleft lip nose deformity patients and no reports for the correlation between degree of the deformity and nasal airway obstruction. The authors selected 34 patients with secondary cleft lip nose deformity and measured the degree of morphological deformity by photo analysis and the degree of nasal airway obstruction by VAS score and acoustic rhinometry. Almost all patients complained of more obstructive symptom on the affected side. Functional anatomic structure and volume of the nasal airway examined by acoustic rhinometry showed that narrowest point was located above the nostril and pathological obstruction was more significant in patient group in both side and the area of the narrowest point and the total nasal volume was smaller in patient group. The result that alar contour difference has correlation with total nasal volume but not with objective symptom shows that there may be other factors affecting the nasal obstruction. Therefore the authors conclude that not only the correction of the external morphologic deformity but also the consideration of nasal airway obstruction is essential when performing operation on the secondary cleft lip nose deformity patients.