Association between in vitro fertilization success rate and ambient air pollution: a possible explanation of within-year variation of in vitro fertilization success rate

Simplified V-Shape Incision Technique for Saving Hair Follicles

BACKGROUND: The scalp is the second most visible part of the anatomy next to the face. Thus, aesthetic considerations such as scars and alopecia are important when planning excision of a mass from the scalp. Aesthetic results have not been satisfactory due to scar widening and hair follicle injury. Many methods have been tried to improve these results, however, they require multiple procedures and longer operation time. METHODS: We evaluated a easy and time-saving V-shape incision for excising a scalp mass. This technique of simplified V-shape incision was performed in 32 patients with benign scalp masses treated from September 2011 to March 2013. The incisions were performed with a blade to make a V-shape margin and preserve deep hair follicles at the flap margins. The defect was closed by approximation of two edges. RESULTS: All tumors were benign and superficial. The size of the scalp masses was 0.4-2.0 cm in width and 1.0-5.0 cm in length. Many hairs from the deep hair follicles grew into the scar, making the scar line almost unnoticeable in all 32 patients. Although some scar widening was evident, the number of hairs per unit was high enough to camouflage the scars. CONCLUSIONS: The simplified V-shape incision was beneficial as a simple, mini-surgical, time-saving procedure. Although the scars were slightly wider, they were covered with penetrating hairs and became unnoticeable.

Review of Keloid Patients with Clinical Experience

BACKGROUND: Keloid management can be difficult and frustrating, and the mechanisms underlying keloid formation are only partially understood. Despite many studies of the pathogenesis and cause, little is known of the predisposing factors or the diathesis. Therefore, we evaluated patients with keloid for 13 years clinical experience, with the goal of considering the causative factors and physical disposition of keloid. METHODS: We evaluated 107 patients (38 males, 69 females; median age 22.31 years, range 7-58 years) who visited the department of plastic and reconstructive surgery from March 1998 to December 2010. The patients' chart and clinical photo were reviewed for the study. RESULTS: Etiologies were an intended wound like piercing or surgical wound (n=39), avulsion flap injury (n=30), laceration (n=29) and burn (n=9). The location were the head and neck (n=38), trunk (n=23), upper extremity (n=21), lower extremity (n=16) and face (n=9). Patients with more than overweight (>23 kg/m2, Body mass index) were 84 in 107 patients (78.5%) with keloids. CONCLUSIONS: In the care of the keloids, patient information, particularly sex, age and body mass index, it may be useful indicators for expecting prognosis of the patients and treating with proper management. Particularly, large-scale accurate follow-up observations on obese patients will be critical.

Migration of a Ruptured, Silicone Gel-Filled Breast Implant into Sternal and Abdominal Areas

A 50-year-old woman visited our hospital for two palpable masses on her sternal and left upper abdominal areas. She had augmentation mammoplasty 12 years prior. Based on the physical examination, the mass in the sternal area was firm, movable, and round. The size of the mass was approximately 3.0x3.0x1.0 cm3. The mass in the upper-left abdomen showed similar characteristics, with a size of approximately 10.0x15.0x1.5 cm3. Ultrasonography revealed a 3.9x1.0x3.4 cm3 hypoechoic lesion in the sternal area. On enhanced-mode computed tomography, a rupture of the left breast implant was noted. Both masses had similar densities as the implant. After rupture of the breast implant, surgery was performed under general anesthesia. Using an inframammary approach, both breast implants and masses were removed using the site of the previous mammoplasty incision. Intraoperative findings revealed that the left breast implant was ruptured and the masses consisted of implant gel components. After surgery, the patient's recovery was uneventful. The patient was discharged without any problem on hospital day 9.

A Clinical Experience of Cleft Palate Repair Using Operative Microscope: Sommerlad's Method

The purpose of this study is to introduce the method of palate repair that combines minimal hard palate dissection and radical retropositiong of levator musculature, which was presented by Sommerlad. As this method presents, additional use of the operating microscope enables atraumatic and radical dissection, and it might provide more improved speech function to the patients. A total of 17 patients with cleft palate underwent Sommerlad's method from December 2003 to August 2004. The mean follow-up period was 4.5 months. The use of a microscope provided high quality variable magnification and good illumination at the operating field. Repair was carried out through incisions at the margins of cleft with mucoperiosteal flap elevation. Muscles were rearranged and repaired properly. It was unable to evaluate the improvement of speech because the patients were too young to learn meaningful speech. Average operating time including anesthetic induction time, V-tube insertion and recovery from anesthesia was 2 hours 45 minutes which was not quite different from conventional method's operating time. Oronasal fistula developed in 2 patients of them. One of them was healed spontaneously. As meticulous and radical muscle dissection was possible with Sommerlad's method, we could minimize the trauma to the muscular and neurovascluar structure. In addition, we expect better faculty of speech as a result of this method although longer follow-up time was unavailable.

Clinical Experience of Cutaneous Squamous Cell Carcinoma Arising in Keratoacanthoma

PURPOSE: The cutaneous squamous cell carcinoma is the second most common skin malignancy. It is noted that keratoacanthoma is difficult to differentiate from squamous cell carcinoma, clinically or historically. It is still a hypothetical question whether keratoacanthoma is a pseudomalignancy or a form of squamous cell carcinoma. METHODS: We report the case of squamous cell carcinoma around left ala of nose in a 64-year-old female patient. Through an incisional biopsy, the mass was found to be keratoacanthoma in the pathologic report. An excisional biopsy was performed. RESULTS: Pathologic report notified that it was found well-differentiated squamous cell carcinoma arising in keratoacanthoma with focal involvement of deep resection margin. Wide excision was made with 0.5-1.5cm margin and immediate reconstruction was performed. CONCLUSION: The relationship between keratoacanthoma and squamous cell carcinoma has been debated in the treatment. It is still controversial whether to excise it or not. We concluded that kerathoacanthoma must be removed completely.

Modified Tenson Band Fixation for Unstable Fracture of the Distal Clavicle / 대한정형외과학회잡지

PURPOSE: The aims of this study were to introduce a new surgical technique for unstable fracture of the distal clavicle, and to evaluate the clinical results. MATERIALS AND METHODS: The clinical results of nineteen patients who underwent surgical treatment for unstable fracture of the distal clavicle, during the period from March 1995 to December 1999, using a modified tension band fixation with follow up over one year were reviewed. Outcome was analyzed in terms of pain, function, radiologic result and union time. RESULTS: All cases showed satisfactory results; eighteen cases (95%) were excellent, and one case (5%) was good. Radiologic union was achieved on average at eight weeks (six-tweleve) after operation. No complications such as pin migration, metal breakage and nonunion were seen. CONCLUSION: Modified tension band fixation for unstable fracture of the distal clavicle was found to be a useful method, which is easy and induces no injury of the acromioclavicular joint, and provides enough stability for postoperative rehabilitation.

Operative Treatment of Degenerative Scoliosis / 대한척추외과학회지

STUDY DESIGN: The retrospective study was designed to propose treatment options of degenerative scoliosis OBJECTIVES: To propose various treatment options based on patients'clinical symptoms & radiologic findings and finally to get a standard treatment options. SUMMARY OF LITERATURE REVIEW: The studies about the treatment options of degenerative scoliosis were few, so we propose the treatment options of degenerative scoliosis. MATERIALS & METHODS: Between January, 1994 and August, 2000, 136 cases of degenerative scoliosis were diagnosed. Among these cases, 45 cases (33%) were performed operative treatment. There were 45 women and 4 men. The average patients age was 62.6 years (range 43~78years). The average follow up time was 23 months (range 12 mon~66 months). Scoliotic angle within curve was measured by Cobb's methods, and rotation of pedicles were measured by Nash and Moe methods. RESULTS: The overall satisfactory clinical results was noted in 37 (82%) of 45 patients. By Kirkardy-Willis questionnaire, 14 cases were excellent, 23 cases were good, 5 cases were fair, 3 cases were poor. Before surgery, average Cobb's angle measured 16 degree (range 7~44 degree), after surgery, this corrected to 9.2 degree (range 2~25 degree). But, degree of improvement in Cobb's angle and one of clinical symptom relief had no statistic correlations (p>0.05). CONCLUSION: 1) When neurologic symptoms were chief complaints, and scoliosis curvature was stable. only decompression surgery should be performed. 2) when mild back pain and neurologic symptoms were chief complaints, and rotatory subluxation at stenotic level, decompression & limited post. instrumentation & fusion. 3) when severe back pain and neurologic symptoms were chief complaints, and scoliosis curvature was unstable, decompression & long post. instrumentation & fusion. 4) When only technical pain-no neurologic symptoms-was a chief complaints, correction & fusion with instrumentation.