Craniofacial surgery and the humanities

No abstract available.

Erratum: Multicenter Survey on the Economic Burden of Pediatric Allergic Rhinitis / 소아알레르기및호흡기학회지

The funding acknowledgment in this article was omitted as published.

Multicenter Survey on the Economic Burden of Pediatric Allergic Rhinitis / 소아알레르기및호흡기학회지

PURPOSE: The prevalence of allergic rhinitis is rapidly increasing and results in relatively high socio-economic burden on their family and community. However, studies on the economic burden of pediatric allergic rhinitis in Korea are limited. Therefore, we conducted this study to investigate the impact of pediatric allergic rhinitis on economic burden. METHODS: Two hundred sixty two children with allergic rhinitis were enrolled in 6 secondary or tertiary medical centers in Seoul from July to September, 2008. We collected data of the economic burden of allergic rhinitis (direct medical costs, direct nonmedical costs, and indirect costs) by face to face questionnaire survey. We compared the economic burden according to the severity and the duration of allergic rhinitis. RESULTS: The mean age of subjects was 6.54 years, and male were 174 (66.4%). Direct medical costs (10,000 Korean Won/yr) were 177.75, and direct nonmedical costs were 57.92. Although, there was no statistical significance, direct medical costs showed increasing trends in severe allergic rhinitis.(P=0.053) In addition, direct medical costs were positively correlated with duration of allergic rhinitis.(R=0.195, P=0.002). About 17% of the parents who care the allergic rhinitis children experienced the work absence due to their child's illness. CONCLUSION: The economic burdens of allergic rhinitis were positively correlated with the severity and duration of illness. Particularly costs for alternative medicine including oriental medicine were related with severity and duration allergic rhinitis. Therefore, special efforts for education with evidence based treatment strategy are necessary to decrease the economic burden of allergic rhinitis.

Impact of Health Insurance Type on the Quality of Hemodialysis Services: A Multilevel Analysis / 예방의학회지

OBJECTIVES: This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. METHODS: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). RESULTS: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI=0.43-0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb> or =11 g/dL, blood pressure within the range of 100-140/60-90 mmHg, calcium x phosphate or =4 g/dL were not significantly different between the groups. CONCLUSIONS: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.

Correction of a Wide Alveolar Cleft with Reverse L Osteotomy and Liou Alveolar Distractor

PURPOSE: A successful surgical treatment for a wide alveolar cleft with bone graft is difficult to achieve due to several factors such as limitation of gingivoperiosteal flap, presence of large scar tissues, and poor blood circulation. To overcome these problems, alveolar distraction osteogenesis using Liou alveolar distraction device was applied. We analyzed the consequences of this surgical treatment. METHODS: From January 2006 to August 2007, we have conducted analysis on the methods and consequences of Liou alveolar distraction osteogenesis for 6 patients. The age of patients was 12 years and 6 months on average. The follow up period was 19months on average. The reverse L osteotomy followed by the placement of the Liou alveolar distraction device was performed. After serial distraction, the distractor was removed after 5 months of the process of osteogenesis. The results were analyzed using the computed tomography and the x-ray films of the alveolar bone and the teeth. RESULTS: The alveolar cleft with 12.5mm on average width was filled with 8.5mm of newly formed bone tissue on average width after 5 months of osteogenesis. Among the 6 cases, 5 required the additional bone graft and 1 case only required the gingivoperiosteoplasty. The newly formed bone tissues did not show any signs of bone resorption. However, a considerable degree of teeth displacement was noted. CONCLUSION: For the alveolar cleft too wide to be reconstructed by a general bone graft, it is strongly recommended to perform the reverse L osteotomy of the cleft side with Liou alveolar distraction device to initiate the alveolar osteogenesis. However, the migrated teeth showed some degree of relapse, thus, the orthodontic treatment is essential following the distraction osteogenesis treatment.

The Relationship between Pain and Stress in Senior Citizens Residing in a Certain District

BACKGROUND: In spite of its high prevalence and social impact, pain in the elderly has not been managed appropriately. Understanding the multidimensional aspect of pain is crucial in its effective management. Patients with chronic pain are known to be more profoundly affected by psychological and social factors. We, therefore, classified chronic pain patients and especially focused on the relationship between pain and stress. METHODS: The subjects were 149 persons older than 60 years attending a certain geriatric college. A survey was peformed employing the Korean version of Geriatric Pain Measure (GPM-K), the Korean Version of Brief Pain Inventory (BPI-K), the Elderly Life Stress Inventory (ELSI), the Perceived Stress Scale (PSS), the Geriatric Depression Scale Short Form-Korea Version (GDSSF-K), and the Revised Chalder's Fatigue Scale (Fatigue). RESULTS: A total of 103 people, who completed both the questionnaires on pain and stress were enrolled. There was a significant correlation between GPM-K and ELSI (ELSI: r=.38, P<0.01). In chronic pain patients, not only ELSI, but also PSS was correlated with GPM-K (ELSI: r=.37, P<0.01, PSS: r=.25, P=0.04). CONCLUSION: There was a significant correlation between GPM-K and ELSI in the elderly. In chronic pain patients, it was more closely associated with GPM-K. We, therefore, believe that stress management can be useful in the management of pain, especially in the management of chronic pain patients.

The Reliability of 3D CT Analysis for Facial Asymmetry

3-dimensional computed tomography(3D-CT) imaging has been used in the diagnosis and surgical treatment planning of patients with craniofacial deformities, but its measurements were not commonly accepted contrary to the measurements in cephalometric analysis which was accepted as the best way to evaluate the facial profile on craniofacial & orthognathic fields. The purpose of this study was to compare the measurements from cephalometric analysis and 3D-CT analysis in facial asymmetric patients in order to show the reliability of the latter. 10 facial asymmetry patients had taken both cephalometry x-ray & 3D-CT. The 8 measurements were obtained from cephalometric analysis and 3D-CT analysis on each patient. The cephalometric analysis was based on the manual tracing of PA cephalometry x-ray film and the 3D-CT analysis was performed using the 'measuring tools' of Medical PACS system. The measurements included the maxillar & mandibular height, mandiblular body length, and vertical & horizontal deviation degree of maxilla and mandible. The paired t-test was used to compare differences between measurements from two methods. And also the ratio(affected side/unaffected side) in 3 measurements was calculated and compared using paired t-test to show the reliability. There were no statistically significant differences between measurements from cephalometric analysis and 3D-CT analysis(P > 0.05) except mandibular body length. Also no statistically significant differences were noted between the ratio of 3 measurements on cephalometric analysis and 3D-CT analysis(P > 0.05). 3D-CT analysis of facial asymmetry presents reliable data as much as cephalometric analysis. Moreover, it is very easy and simple method to use. The 3D-CT analysis as described herein is a practical method of evaluation the morphology of facial asymmetry and can replace the cephalometric analysis.

Preoperative Nasal Molding and Unilateral Cleft Lip Repair By Mohler'S Technique

Various techniques of unilateral cleft lip repair are being developed. Nowadays, rotation-advancement flap technique is most widely used for the repair of unilateral cleft lip. This procedure places a premium on the conservation of tissue and preservation of natural landmarks. Millard's technique however occasionally can produce a scar that crosses the philtrum obliquely in the upper third of the philtral unit. In Mohler's technique, the marking of the medial segment has been altered in uppermost portion by utilizing tissue from the columellar base. That is to say, cutback on columellar tissue is utilized at approximately 90 degrees. After full-thickness release of the medial lip segment, the C flap is advanced into donor defect of the columellar base and is also used to lengthen the shortened columella. This results in the placement of a scar that will simulate the mirror image of the non-involved phitral column. And another advantage of this technique is the possibility of primary nasal correction including wide dissection of alar cartilage through cutback incision on columellar base without need of additional incision for nasal dissection. In addition, preoperative nasal molding was performed with a special NAM(nasoalveolar molding) appliance by orthodontist during preoperative period. The authors performed 27 cases of the correction of the unilateral cleft lip using this technique between July 2000 and December 2001. All the patients showed satisfactory results by achieving enough rotation of medial lip segment without scar that crosses the philtral column and satisfactory correction of primary nasal deformity.

Transvginal Sonography in the Prediction of Preterm Labor / 대한주산의학회잡지

OBJECTIVE: Preterm labor and delivery is probably the largest problem in modern perinatology. The early diagnosis of preterm labor is crucial for prevention of preterm birth. To predict the onset of preterm labor, we examined the diagnostic performance of serial cervical assessment by transvaginal sonography. METHODS: In this prospective study, we performed transvaginal sonography at approximately 30 and 34 weeks of gestation in women with singleton pregnancies. Cervical parameters evaluated included endocervical length, the presence of funneling, funnel length and funnel width. We then assessed the relation between cervical parameters and the risk of spontaneous preterm labor. RESULTS: We examined 258 women at approximately 30 weeks of gestation and 247 of these women again at approximately 34 weeks. Spontaneous preterm labor occurred in 9 of women examined at 30 weeks(Group 1) and in 13 at 34 weeks(Group 2). The endocervical length was normally distributed at 30 and 34 weeks(mean +/-SD, 38.26+/-6.82mm and 35.63+/-7.35mm, respectively). The endocervical length decreased significantly from 30weeks to 34 weeks(p=0.0001). Both groups showed significantly shorter endocervical length(p <0.05) and groupl more presence of funneling than group of term pregnancy(p<0.05). Receiver-operator characteristic curve and multiple logistic regression analyses indicated that endocervical length <-30mm at 30 weeks and <-25mm at 34 showed highest diagnostic index in predicting the onset of preterm labor(p=0.0001). Conclusions: Serial transvaginal ultrasound assessment of endocervical length during early third trimester is a useful predictor of preterm labor and delivery in low-risk patients.