Minimally invasive facial rejuvenation combining thread lifting with liposuction: A clinical comparison with thread lifting alone

BACKGROUND: Barbed thread lifting is known to be a minimally invasive procedure compared with standard incisional surgery for facial rejuvenation. However, some studies have pointed out that the effects of thread lifting do not last long and disappear after several months. Therefore, the aim of this study was to evaluate the efficiency and duration of anchoring-type absorbable thread lifting combined with liposuction for facial rejuvenation. METHODS: A retrospective review of 27 cosmetic patients who underwent absorbable barbed thread lifting with liposuction between July 2013 and December 2015 was undertaken. The efficiency of facial rejuvenation was evaluated through a patient satisfaction score and the global aesthetic improvement scale (GAIS). RESULTS: Subjects were divided into two groups: thread lifting only and thread lifting combined with liposuction. The mean follow-up period of each group was 8.5 and 9.3 months, respectively. In the thread lifting-only group, the average patient satisfaction score was 2.36 (1=unsatisfied to 4=very satisfied), and the average GAIS score was 2.54 (1=very much improved to 5=worsen). In the thread lifting with liposuction group, the average patient satisfaction score was 3.06, and the average GAIS score was 1.85. CONCLUSIONS: Thread lifting combined with liposuction showed better patient satisfaction and GAIS results than thread lifting alone, even over a long follow-up period.

Early Complications from Absorbable Anchoring Suture Following Thread-Lift for Facial Rejuvenation

BACKGROUND: Thread lifting has been known as a minimally invasive procedure compared with the standard incisional surgery for facial rejuvenation. Although there have been several reports on acute or delayed complications after using nonabsorbable thread type, there have only been a few studies on such complications after using absorbable thread type. Hence, the aim of this study was to introduce various complications of thread lifting using the absorbable anchoring type for facial rejuvenation and to discuss about how to resolve it. METHODS: A retrospective review of 144 cosmetic patients, who underwent absorbable barbed thread lifting between July 2013 and December 2015, was performed. The procedure was done using the temporal anchoring technique. The thread used in this study are polydioxanone molding cog (PMC) and polydioxanone cutting cog (PCC), which are both the absorbable type. RESULTS: The results are as follows: Dimple was developed in 3 cases (2.1%); thread exposure was developed in 5 cases (3.5%); alopecia was developed in 3 cases (2.1%); undercorrection was developed in 3 cases (2.1%); asymmetry was developed in 1 case (0.7%); and parotid gland injury was developed in 1 case (0.7%). Out of the total 144 patients, sixteen (11.1%) patients developed at least 1 complication. There was no detectable inflammation or consistent skin excavation. CONCLUSIONS: Most complications of absorbable thread lifting are minor ones, and such complications resolve by retouching or widening the anchoring gap, but it is important to keep in mind the possibility of parotid gland injury.

Endovascular Management of Spontaneous Superficial Femoral Artery Pseudoaneurysm in a Renal Allograft Patient

We report a case of a superficial femoral artery pseudoaneurysm in 52-year old patient with a history of having renal allograft. The pseudoaneurysm spontaneously developed while standing up from squatting position after defecation, and it was successfully managed by an endovascular repair with an endograft. This case suggests that an atherosclerotic superficial femoral artery is vulnerable to torsion and tension movement during changing position from squatting to standing, which is repeatedly practiced by the people using the Korean traditional toilet. The endovascular therapy is also recommended for elderly patients with poor clinical conditions such as having a renal allograft and diffuse atherosclerosis of peripheral arteries.

Large Coronary Artery Aneurysm with Thrombotic Coronary Occlusion Resulting in ST-Elevation Myocardial Infarction after Warfarin Interruption

A 44-year-old man, who had a history of myocardial infarction (MI) due to thrombotic occlusion of right coronary artery (RCA) aneurysm, visited emergency department presenting with ST-segment elevation myocardial infarction (STEMI). The patient had been on oral anticoagulant therapy (warfarin) from the first thrombotic event, but the medication had been recently changed to aspirin 4 months before the second event. Emergent coronary angiography revealed thrombotic total occlusion of RCA with heavy thrombotic burden from middle RCA to the ostium of the posterior descending branch. Combination pharmacotherapy was performed with anticoagulants (heparin), fibrinolytics (urokinase), and Glycoprotein IIb/IIIa antagonists (abciximab), in addition to mechanical thrombosuction. However, on hospital day 2, the patient complained recurrent chest pain and again underwent coronary angiography, which revealed distal embolization of large thrombus to the posterior lateral branch. Coronary flow was recovered after repeated mechanical thrombosuction was performed. This case has shown the importance of aggressive combination drug therapy, accompanied by mechanical thrombosuction in patient with myocardial infarction due to thrombotic occlusion of coronary artery aneurysm and the importance of unceasing life-long anticoagulant therapy in those particular patients.

Forehead Contouring Augmentation Surgery with Particulated Mandibular Bone Graft

Up to this date, the forehead contouring augmentation surgery was perfomed with silicone or microfat graft. However, augmentation with silicone has given complications such as postoperative infection, extrusion, long linear scar, and displacement of implant. Moreover, augmentation using microfat graft often requires re-operation due to fat resorption. Surgical technique was performed in 10 patients from September 2008 to April 2009. Eight patients had macrogenia and two had prognathism. Particulated bone was harvested from squared mandibular bone. The particulated mandibular bone was then grafted on the frontal bone through a 2cm incision posteriorly to the midforehead line. As a result from the three-dimensional Computer Tomogram, the frontal bone was engrafted 6 months after the particulated bone graft. Even though, traditional concept using prothesis for forehead augmentation is still popular, the author suggests autologous augmentation can make better facial contour which is named as 'facial bone redistribution concept'. Facial bone redistribution concept is the distribution of residual bone(mandible or zygoma) to deficient area(frontal bone) to achieve better facial contour. To achieve better survival rate of bone, bone marrow stem cell and platelet rich plasma(PRP) should be applied in next study to increase the survival rate of particulated bone.

Erratum Announcement

No abstract available.

Superior Orbital Fissure Syndrome after Repair of Blow Out Fracture

PURPOSE: Superior orbital fissure syndrome is a rare neurological complex. Superior orbital fissure syndrome may result from a variety of inflammatory, infectious, neoplastic, iatrogenic, traumatic, vascular cause. The author report a patient who suffered from superior orbital fissure syndrome after inferior orbital wall reduction. METHODS: A 26-year-old female suffered from inferior orbital wall fracture with inferior gaze limitation and orbital soft tissue herniation. On posttrauma 10 day, inferior orbital wall was reduced using endoscope and porous polyethylene(Medpor(R)) was inserted. On immediate postoperation, she reported that extraocular movement was limited in almost any directions. She underwent exploration surgery to release the presence of extraocular muscle impingement. But, there was no observation of extraocular muscle impingement. On postoperative one day, high- dose steroid therapy was started to release superior orbital fissure syndrome which was defined in postoperative computed tomography. RESULTS: After one month of high-dose steroid therapy, extraocular movement limitations improved progressively in all directions. In four months, extraocular movement recovered completely. CONCLUSION: Superior orbital fissure syndrome may occur after surgical procedure of orbital wall reduction. Prompt diagnosis and treatment with mega-dose corticosteroid is an effective option for avoiding disaster from compressive syndrome.

A Simple Evaluation Method Using a "Sun-Wukong's Headband" Wire for Positional Plagiocephaly Correction after Cranial Remodeling Helmet Therapy

PURPOSE: A cranioremodeling helmet for correcting plagiocephaly was recently developed. However, no discrete objective methods to evaluate how the deformity is being corrected have been developed. We have established an easy and cost-effective method that can be used not only to show the correction process, but can also be used by physicians to assess the degree of plagiocephaly two-dimensionally. METHODS: For two-dimensional evaluation, a length of malleable memory wire (2 mm in diameter) resembling "Sun-Wukong's headband" was placed on the patient's head. The wire around the patient's head was positioned on a plane including points 1 cm above the eyebrow and 1 cm above the auricle. The wire was placed on a sheet of paper and the outline was marked using pens of various colors during each visit. The degree of plagiocephaly correction could then be shown to the patient's parents at every consultation. RESULTS: The method established by the present study easily shows the horizontal cross-section transformation of the head, illustrates plagiocephaly correction by the helmet, and shows the degree of correction in a two-dimensional manner. CONCLUSION: A soft-shell helmet is widely used for correcting plagiocephaly. However, evaluating the effectiveness of the helmet has been determined in a subjective manner, and a more objective method is now in demanded. Our study found that a "Sun-Wukong's headband" wire can accurately measure two-dimensional changes. Future studies will be required to identify landmarks needed for assessing plagiocephaly correction.

Correction of Problems after Eyelid Surgery using Various Techniques

Many techniques for prevention and correction of complication after blepharoplasty have been developed, however, satisfactory method has not yet been documented. The purpose of this article is to review common unfavorable complications after Asian cosmetic eyelid surgery, and to propose several methods of treatment for effective correction. From 1988 to 2008, authors reviewed 364 cases(480 eyes) of complications after cosmetic eyelid surgery. Follow-up period ranged from 6 months to 16 years. The results of treatments were classified into excellent, good, fair and unsatisfactory by operating surgeons, other surgeons, and by patients. About 40% of complications requiring revisional surgeries were treated early within 2 weeks after first operation. Other 60% of complications were treated by late reoperations, at least 6 months after first surgery. Majority of patients were satisfied with the results. However, a few patients reported unsatisfactory outcomes which required additional revisional procedures. The correction of complications following cosmetic eyelid surgery remains a difficult task. The strategies for successful Asian upper blepharoplasty include not only careful preoperative evaluation and delicate operative technique, but also, proper postoperative interventions such as early secondary blepharoplasty.

Risk factors related to progressive traumatic intracerebral hematomas in the early post head injury period

PURPOSE: In this study, patients in whom two computed tomography (CT) scans had been obtained within 24 hours of injury were analyzed to determine the incidence, risk factors and clinical significance of a progressive intracerebral hematoma (PIH). METHODS: Participants were 182 patients with a traumatic intracerebral hematoma and contusion who underwent a repeat CT scan within 24 hours of injury. Univarite and multivariate statistics were used to define growth (volume increase) and to examine the relationship between the risk factors and hemorrhage expansion. RESULTS: Fifty-four percent of the patients experienced progression in the size of the lesion in the initial 24 hours postinjury. A PIH was independently associated with worsened Glasgow coma scale (GCS) score (2.99, 1.04~8.60), the presence of subarachnoid hemorrhage (6.29, 2.48~16.00), the presence of a subdural hematoma (6.18, 2.13~17.98), the presence of an epidural hematoma (5.73, 1.18~27.76), and the presence of a basal cistern effacement (10.93, 1.19~99.57). CONCLUSION: For patients undergoing scanning within 2 hours of injury, the rate of PIH approaches 61%. Early repeated CT scanning is indicated in patients with a nonsurgically-treated hemorrhage revealed on the first CT scan. Worsened GCS score, significant hematoma growth and effacement of the basal cisterns on the initial CT scan are powerful predictors of which patients will require surgery. These findings should be important factors in understanding and managing of PIH.

A More Detailed Classification of Mild Head Injury in Adults and Treatment Guidelines

OBJECTIVE: The purpose of this study was to analyze risk factors that are associated with intracranial lesion, and to propose criteria for classification of mild head injury (MHI), and appropriate treatment guidelines. METHODS: The study was based on 898 patients who were admitted to our hospital with Glasgow Coma Scale (GCS) score of 13 to 15 between 2003 and 2007. The patients' initial computerized tomography (CT) findings were reviewed and clinical findings that were associated with intracranial lesions were analyzed. RESULTS: GCS score, loss of consciousness (LOC), age and skull fracture were identified as independent risk factors for intracranial lesions. Based on the data analysed in this study, MHI patients were divided into four subgroups : very low risk MHI patients are those with a GCS score of 15 and without a history of LOC or headache; low risk MHI patients have a GCS score of 15 and with LOC and/or headache; medium risk MHI patients are those with a GCS score of 15 and with a skull fracture, neurological deficits or with one or more of the risk factors; high risk MHI patients are those with a GCS score of 15 with abnormal CT findings and GCS score of 14 and 13. CONCLUSION: A more detailed classification of MHI based on brain CT scan findings and clinical risk factors can potentially improve patient diagnosis. In light of our findings, high risk MHI patients should be admitted and treated in same manner as those with moderate head injury.

Role of Nitric Oxide in Leukocyte-Endothelial Interaction in Cerebral Venules during Reperfusion after Global Ischemia

OBJECTIVE: Reactive oxygen metabolites and polymorphonuclear leukocytes have been implicated in the pathophysiology of reperfusion injury. The mechanisms involved in superoxide-mediated leukocyte adherence remain unclear, however, nitric oxide(NO) may contribute to this response. The present study is undertaken to elucidate mechamisms controlling NO based mechanisms that regulated leukocyte-endothelial interactions in the cerebral vasculature after global cerebral ischemia and reperfusion. METHODS: Pial venular leukocyte adherence of anesthetized newborn piglets was quantified by in situ fluorescence videomicroscopy through closed cranial windows during basal conditions and during 2hours of reperfusion after global ischemia induced by 9minutes of asphyxia. Nitric oxide synthase(NOS) was inhibited by local window superfusion of L-nitroarginine(NA); superfusion of sodium nitroprusside(SNP) was used to donate NO. RESULTS: The mean number of adherent leukocytes to cerebral venules in the 9minutes asphyxia and 2hours reperfusion group were 161+/-19 compared with 13+/-4 in the nonasphyxial group. Superfusion of L-NA through the cranial window for 2hours resulted in leukocyte adherence similar to that observed during the initial 2hours of reperfusion after asphyxia. Leukocyte adherence was not additionally increased in asphyxic animal treated with L-NA. SNP inhibited asphyxia induced leukocyte adherence back to control levels. CONCLUSIONS: Nitric oxide inhibits leukocyte adherence to cerebral venules during the initial hours of reperfusion after asphyxia, and that NO supplementation inhibit asphyxia induced leukocyte adherence back to control levels. These results indicate that NO is an important factor in ischemia-reperfusion induced leukocyte adherence.

A Case of He rpes Zoster Meningitis with Involving Multiple Dermatomes

Herpes zoster is manifested by varicella zoster virus(VZV) that involve nerve ganglions. It may be self limited, but some may have complications or sequelae, such as postherpetic neuralgia, optic neuritis, external ocular motor nerve palsy, facial nerve palsy, encephalitis or hemiplegia. It usually involves posterior root ganglia, but there are few case reports involving multiple dermatome with meningitis simultaneously. We report a patient with herpes zoster meningitis involving with multiple dermatome. A 64 year-old female presented with intractable headache, vomiting, and multifocal skin eruptions. Physical examination showed multiple vesicular eruptions on right forehead and upper limb along the dermatomes of V1, C4, C5, C6, C7. There was no localizing or lateralizing sign except for neck stiffness. Brain CT showed no abnormal finding. In the CSF study, the opening pressure was 200 mmH2O and cell count was 36/mm3 in RBC, 1,043/mm3 in WBC(95% lympho-dorminant). The level of protein and glucose were 671mg/dL, 127 mg/dL(serumglucose 270 mg/dL), respectively. It was positive in VZV-PCR, and was negative in tumor marker studies. Under the diagnosis of Herpes zoster meningitis, she was treated and improved with antiviral agent(acyclovir). We report a patient with herpes zoster meningitis involving polydermatomes simultaneously.

Fluid Attenuated Inversion-Recovery Magnetic Resonance Imaging of Acute Subarachnoid Hemorrhage: Comparison with Non-Contrast-Enhanced Computed Tomography

OBJECTIVE: Our aim is to evaluate the usefulness of fluid-attenuated inversion recovery(FLAIR) magnetic resonance(MR) imaging for detection of acute subarachnoid hemorrhage(SAH) compared with non-contrast-enhanced computed tomography(CT). METHODS: We compared FLAIR MR images with non-contrast-enhanced CT scans in 34 patients with acute SAH. Findings of SAH on CT and MR images were graded as 0(absence), 1(suspicious), and 2(definite) in the cerebral sulci, sylvian fissures, basal cisterns, and cisterns of the posterior cranial fossa. We also compared FLAIR MR images of 34 patients with those of 35 normal subjects, and then the sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of acute SAH were calculated. RESULTS: FLAIR MR image was superior to CT in detecting SAH in the cranial fossa posterior(1.41+/-0.74 vs. 0.78+/-0.80, p<0.05) and cortical sulci(1.11+/-0.80 vs. 0.70+/-0.83 p<0.05). There was no significant difference between FLAIR MR image and CT in detecting SAH in the basal cisterns and sylvian fissures. The sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of SAH were 100% in all. CONCLUSION: FLAIR MR image is useful in detecting acute SAH, especially in patients with SAH in the posterior cranial fossa and cerebral sulci.

Comparison of Fluid-Attenuated Inversion-Recovery Magnetic Resonance Imaging with Computed Tomography in Acute Intraventricular Hemorrhage

OBJECTIVE: Our aim is to evaluate the usefulness of fluid-attenuated inversion recovery(FLAIR) magnetic resonance(MR) imaging for detection of acute intraventricular hemorrhage(IVH) compared with pre-contrast computed tomography(CT). METHODS: Twenty-eight patients with acute IVH were evaluated with FLAIR MR imaging and precontrast CT. All MR and CT examination were performed within two days from symptom onset. One neurosurgeon and one radiologist evaluated the detectability and conspicuity of acute IVH on FLAIR MR imaging and pre-contrast CT. RESULTS: Acute IVH was detected in all patients on FLAIR MR imaging and in 23(82%) of 28 patients on pre-contrast CT. The conspicuity of IVH on FLAIR MR imaging was as good as or better than that on pre-contrast CT in 28 patient. CONCLUSION: It is suggested that FLAIR MR imaging is superior to pre-contrast CT in the diagnosis of acute IVH.

The Factors Affecting Enlargement of Spontaneous Intracerebral Hemorrhage

OBJECTIVE: The goal of this study is to evaluate the incidence and factors of hematoma enlargement in patients with spontaneous intracerebral hemorrhage(ICH). METHODS: We analyzed 149 cases with spontaneous ICH who underwent computerized tomography (CT) scans from January, 1995 to December, 1998. The clinical characteristics, past medical history, laboratory findings, time intervals between onset of ICH and CT scan, CT findings and results of treatment were reviewed. RESULTS: Of the total 149 patients, 28(18.8%) had hematoma enlargement, of whom 24(85.7%) underwent a first CT scan within 3 hours after onset of ICH. The incidence of hematoma enlargement significantly decreased in patients who had CT scans 3 hours later after attack. Age, sex, and site of hematoma were not related to hematoma enlargement. Patients with an irregularly shaped hematoma, inhomogenous hematoma and large hematoma had a high risk of hematoma enlargement. Hematoma enlargement was associated with a poor clinical outcome and high mortality(46.7%). CONCLUSION: Patients admitted to a hospital within 3 hours of onset of ICH, and patients with inhomogenous hematoma on CT scan, irregularly shaped hematoma, or large hematoma should be closely observed for hematoma enlargement.

Differences in p53 Protein Expression between Delayed and Completed Focal Cerebral Infarction in Rats

OBJECTIVE: We investigate and compare geometric patterns and degree of p53 protein expression in a peri-infarction area between two different types of cerebral infarction, delayed and completed focal cerebral infarctions. METHODS: For the delayed focal cerebral infarction group(Group 1 ; n=8), right middle cerebral artery(MCA) and bilateral common carotid artery(CCA) were ligated temporarily for thirty minutes, and their brains were obtained after 72 hours. For the completed focal cerebral infarction group(Group2 ; n=11), right MCA and CCA were occluded permanently, and contralateral CCA was occluded for thirty minutes, and their brains were obtained after 24 hours. RESULTS: The infarction volume was significantly larger in Group 2(267.2+/-29.6mm3) than that of Group 1(10.4+/-2.7mm3)(p<0.001). The width of p53 protein positive area was significantly longer in Group 1(107.8+/-60.5micro meter) than that in Group 2(75.0+/-7.1micro meter)(p<0.05). The density of p53 positive cell was more compact in group 2(48.2+/-1.7cells/HPF) than group 1(28.3+/-9.1cells/HPF)(p<0.001). CONCLUSION: It is suggested that the decreased p53 protein expression in the delayed infarction has certain roles other than apoptosis. The degree of p53 protein expression in the completed focal cerebral infarction seems to be closer to a critical level of gene expression that might determine cell death.

Carotid Artery Intima-Media Thickness and Large-Artery Atherosclerotic Cerebral Infarction

BACKGROUND: Carotid artery intima-media thickness (IMT) is an early structural marker of the atherosclerotic processes and an increased carotid IMT is a strong predictor of stroke. The measurement of carotid IMT is a useful non-invasive measure in risk stratification of ischemic stroke. The objective of the present study is to evaluate whether mea-surement of carotid IMT contributes to the prediction of large-artery atherosclesrotic cerebral infarction. METHODS: By TOAST classifications, 88 patients with ischemic stroke [67 with large-artery disease (LAD) and 21 with small-artery disease (SAD)] were selected from a stroke registry (2000.7~2001.7). Carotid IMT was defined as the mean of IMT measured by B-mode ultrasonography (12 MHz linear probe) at 10 sites of both distal common carotid arteries. The dif-ferences of carotid IMT were analyzed statistically between the LAD and SAD groups according to age or sex. RESULTS: The carotid IMT was 0.84+/-0.08 mm for the LAD and 0.77+/-0.04 mm for the SAD groups. There were no statistically significant differences (p > 0.05) of carotid IMT(total, age, sex) between the LAD and SAD groups. CONCLUSIONS: In this study, the carotid IMT was not associated with LAD as wells as SAD. However, with the increase in age, there is a tendency to increase the differences of carotid IMT between LAD and SAD groups.

The Effects of Lipoxygenase and Cyclooxygenase Inhibitors to Meningioma Cell Proliferation in vitro

No abstract available.

A Clinical Analysis on Traumatic Subarachnoid Hemorrhage

No abstract available.