Robot-assisted submandibular gland excision via modified facelift incision / 대한악안면성형재건외과학회지

BACKGROUND: The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. CASE PRESENTATION: The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar curved scissors and Maryland bipolar forceps) successfully in a 44-year-old female patient who suffered from sialolith and severe atrophic submandibular gland. CONCLUSIONS: If similar studies are done in the future, this robot-assisted sialadenectomy may become established as an alternative to existing disadvantageous surgical methods.

What does integrative medicine mean to the physician and the ministry of health and welfare?

Our aging society, rapid growth of diseases resulting from unhealty habits, frequent occurrences of sickness, and variations in the awareness of health by patients, the worldwide need for integrative medicine, which means the incorporation and integration of complementary and alternative medicine (CAM) into conventional medical systems, is growing rapidly. The most widely available forms of CAM in the treatment of diseases in the U.S. and Europe are acupuncture, chiropractic, phytomedicine (western herbal medicine), mind-body therapies, and nutrition therapy. The well-known hospitals in the U.S. and in Europe (e.g., Harvard, Memorial Sloan-Kettering Cancer Center, Duke, Maryland, Essen, and Humboldt) are offering integrative medicine. The clinical practices as well as the education on CAM of medical schools is becoming more widespread in Korea. It is critical for us as physicians to be aware that the role of CAM is to support and complement conventional medicine, not to substitute for it. To manage chronic diseases effectively, it is imperative for physicians to incorporate and integrate Korean oriental medicine as well as CAM into the conventional medical systems. It is the duty of the medical universities and hospitals to integrate care delivery proven by CAM therapies into the conventional medicine and to develop the standard curriculum for integrative medicine at the undergraduate and graduate levels. To globalize Korean oriental medicine and to scientifically prove the efficiency of CAM, the role of integrative medicine is critical. One of the most important roles of the Ministry of Health and Welfare is to support the hospitals in which integrative medicine is systematically practiced and financially supported. In order to successfully accomplish integrative medicine in Korea, it is important to not only establish an integrative medicine center, but to also develop the contents and clinical pathway along with legal systems regarding integrative medicine with the support of the specialists in the field of integrative medicine.

Analysis of death cases involved in TASER in the State of Maryland / 法医学杂志

OBJECTIVE@#To evaluate the features of autopsy cases involved in electronic weapon (TASER) in the State of Maryland, and to discuss the appraisable points.@*METHODS@#Thirteen autopsy cases involving TASER were collected from 2004 to 2011 in the Office of the Chief Medical Examiner, State of Maryland. All the cases include detailed scene investigations, complete autopsy, toxicological analysis and histopathological examination. Statistical analysis were conducted including general information of victim, type of TASER, type of contact, toxicological results, manner and cause of death.@*RESULTS@#Majority of victims were male with an acute onset of agitated and delusional behavior. Drugs were often involved. Deaths were attributed to multiple factors.@*CONCLUSION@#Most of cases involved in TASER resulted from multiple fatal factors. Further researches are needed for the principal mechanism. Thorough scene investigation and complete autopsy examination play crucial role in evaluation of such cases.

First Metatarsal Dorsal Close Wedge Osteotomy Combined with Medial Cuneiform Plantar Open Wedge Osteotomy for the Treatment of a Cavus Foot / 대한정형외과학회잡지

PURPOSE: We wanted to analyze the results of the 1st metatarsal dorsal close wedge osteotomy (MTDW) combined with medical cuneiform plantar open wedge (MCPOW) for treating forefoot deformity of a cavus foot. MATERIALS AND METHODS: We retrospectively analyzed 30 patients. Their mean age was 21.5 years (SD 10.6 years) and the average follow-up period was 2.3 years. Thirty-four cases of thirty patients were classified as group A, as classified by the 1st MTDW combined with the MCPOW, 16 feet (14 patients) were group B by the 1st MTDW or MCPOW, 12 feet (10 patients), and group C by triple arthrodesis, 6 feet (6 patients). We evaluated the ankle dorsiflexion, plantarflexion, heel alignment, and the Maryland foot score (MFS) preoperatively and the last follow-up, and we analyzed the radiologic Hibb, Meary, calcaneal pitch and tibiotalar angles. RESULTS: The ankle dorsiflexion (p=0.01), plantar flexion (p=0.03) and heel alignment (p=0.02) of group A were significantly improved more than that of groups B and C. The MFS of group A revealed better than group B and C (p=0.01). The Meary (p=0.01), Hibb (p=0.02) and calcaneal pitch angle (p=0.02) of group A were significantly improved more than that of groups B and C. CONCLUSION: 1st MTDW combined with MCPOW osteotomy that focuses at the apex of the deformity for correction of a cavus foot can obtain better clinical and radiological results than other surgical procedures.

Open Reduction and Internal Fixation with AO Calcaneal Plate for Displaced Intra-articular Calcaneal Fracture

PURPOSE: To evaluate the surgical outcomes of open reduction and internal fixation of AO calcaneal plate in displaced intra-articular fractures of the calcaneus. MATERIALS AND METHODS: From January 2004 to July 2007, 25 patients with 27 displaced intra-articular calcaneal fractures were treated by open reduction and internal fixation using the AO calcaneal plate. Preoperative, postoperative evaluations and a follow-up after 1 year were done radiologically by the Bohler angle, Gissane angle, heel height and width among all patients. Their functional status was assessed by means of the Maryland foot score. RESULTS: The mean Bohler angle, Gissane angle, heel height and width were restored comparing with preoperative data. However, in Sanders type IV, some losses of reduction occurred at 1 year follow-up (p<0.05). The mean Maryland foot scores were 85 points in type II, 82 points in type III and 63 points in type IV. Sanders types significantly affected the clinical results (p<0.05). CONCLUSION: The AO calcaneal plate fixation using extensile L-shpaed lateral approach shows satisfactory radiologic and clinical results in the treatment of displaced intra-articular calcaneal fractures.

Analysis of the Deformities of the Foot after Tibial Fracture and Outcome of the Surgical Treatment / 대한족부족관절학회지

PURPOSE: We wanted to evaluate the relating factors for deformities of the foot after tibial fracture and the outcome of respective surgical treatment. MATERIALS AND METHODS: We studied thirty-two patients (thirty-five feet) who had foot deformities after tibia fracture. The age, gender, shape, location, concurrent soft tissue injury and operative treatment of tibial fracture were analysed and outcome of the surgical treatment was investigated. RESULTS: Deformities of the foot mostly occurred in open fractures of Gustilo type 3 or closed fracture with severe soft tissue injury. Variable surgical treatments such as simple release, lengthening, Z-plasty and osteotomy were performed. The AOFAS ankle-hind foot scale was improved from average of 37.3 points preoperatively to an average of 77.2 points at the last follow up. The Maryland foot score was from 42.9 to 90.2 and AOFAS Lesser Toe Metatarso-phalangeal interphalangeal scale was from 42.9 to 90.5. Radiological correction was also improved from 21.9 degrees to 7.9 degrees (Meary angle), from 112.2 to 138.5 (Hibb's angle) and from 33.8 to 25.9 (Calcaneal pitch). CONCLUSION: We proposed that great care should be taken of treatment for the tibial fracture and early detection and proper management of the foot deformities are crucial.

Single Dorsal Incision Technic for Hallux Valgus Surgery / 대한족부족관절학회지

PURPOSE: In this study, we introduced a newly developed technique of operation for hallux valgus. We used a single dorsal incision to correct major components of Bunion in stead of two or three incisions, which had been used by most of surgeons for long time. MATERIALS AND METHODS: Between 2003 and 2005, 27 feet with hallux valgus deformity were operated through single dorsal incision. 10 out of 17 patients underwent operation on both feet, 5 patient underwent operation on left feet, remaining 2 underwent operation on right. There were 16 women and 1 man. Average age of patients was 45 (range, 21-59). Post operatively all feet were evaluated by physical examination, Maryland Foot score profile, radiographic measurements and complication. RESULTS: Maryland foot score profile increased from preoperative 67/100 to postoperative 95/100. Most patients satisfied pain relieve and cosmesis. Average preoperative intermetatarsal angle was 15 degrees, which were decreased to 9 degrees after operation and average preoperative hallux valgus angle was 32 degrees, which were decreased to 12 degrees after operation. CONCLUSION: According to our experience, the single dorsal incision technic for correction of moderate to severe hallux valgus deformities was rather safe and easily performed without noticeable complication with almost same results as multiple incisions technics. We highly recommend this technic to be tried by foot surgeons without hesitation.

Treatment of Displaced Intra-articular Calcaneal Fractures Using a F-plate

PURPOSE: To evaluate the clinical efficacy of F-plate in displaced intra-articular fractures of calcaneus. MATERIALS AND METHODS: Total 43 cases treated with F-plate and followed up at least six months postoperatively were reviewed. Radiographically, Böhler angle was measured and all cases were subdivided by Sanders classification. Each case was reviewed for the presence of local infection, traumatic arthritis, nonunion, and any breakage of plate or screw. Maryland foot score was used for clinical assessment and factors influencing on clinical results were determined. RESULTS: The mean Böhler angle was improved from 0.5° (range: -24.7~35.5°) preoperatively to 25.8° (range: 14.2~38.6°) postoperatively and the angle at last follow-up was 23.5° (range: 10.2~37.5°), showing about 2.3 degree decline compared to postoperative Böhler angle. There were two cases of F-plate breakage and two cases of screw breakage but the metal breakage did not affect any change in Böhler angle. Other complications were; five cases of traumatic arthritis, one case of varus malunion and one case of deep wound infection. According to Maryland foot score, there were 10 excellent, 22 good, 10 fair and 1 poor result. Furthermore, Age, pre-operative Böhler angle and the patient's expectation on financial compensation had significant influences upon the clinical result. CONCLUSION: F-plate fixation seems to yield firm fixation and satisfactory clinical results in the treatment of displaced intra-articular fractures of calcaneus.

A Case of Miller-Dieker Syndrome without Characteristic Facial Anomaly / 대한진단검사의학회지

Miller-Dieker syndrome is a multiple malformation syndrome characterized by severe lissencephaly and characteristic facial abnormalities at birth. It is associated with visible or submicroscopic deletions within chromosome 17p13.3 including PAFAH1B1 (LIS1) gene. We report a six-month-old boy who presented with spasm and generalized myoclonic seizures. The patient was born at 40 weeks' gestation to a 36-year-old woman and showed developmental delay without microcephaly or prominent facial abnormality. Magnetic resonance imaging of the brain showed a few gyrus (lissencephaly). High resolution cytogenetic analysis from peripheral blood showed a normal karyotype. However, fluorescence in situ hybridization (FISH) of the metaphase chromosome using Miller-Dieker/ILS probe (Oncor, Gaithersburg, Maryland, USA) revealed only one signal of probe, indicating a microdeletion of 17pl3.3 region including PAFAH1B1 (LIS1) gene. We suggest that FISH 17p13.3 studies should be performed in addition to a standard metaphase analysis in patients with lissencephaly even if facial anomaly is not noted. A confirmatory diagnosis using FISH would be helpful in terms of leading to allow genetic counseling and availability prenatal diagnosis to the family.

The Results of Renal Transplantation after Lymphocyte Cross-match Negative Conversion by Combination Therapy with Plasmapheresis, Intravenous Gamma Globulin and Potent Immunosuppresants in Patients with Positive LCM / 대한이식학회지

PURPOSE: It is well-known that kidney transplantation cannot be done if recipient has circulating antibodies showing positive lymphocyte cross-match (LCX) to organ donor. In the United States and European countries, the incidence of positive LCX to cadaveric donors in patients who are on the waiting list is up to 20~40%. Unfortunately, these patients also show high rate of positive LCX to live donors when they have donor candidates in their family members and have to be on dialysis until compatible donor comes up. Recently, Eugene J Schweitzer and his associates at the University of Maryland used the combination therapy with plasmapheresis, intravenous gamma globulin and potent immunosuppression to induce negative conversion of LCX in patients who were LCX positive to their living donors and reported the good results after the trial. We did the combination therapy in patients who had positive LCX to their living donors and reported the results. METHODS: Seven patients, four women and three men who showed positive LCX to their living donors, underwent the conversion trials between January 1 and July 31, 2002. The mean age of patients was 43.86 (35~60) and the duration of dialyses varies from 9 to 120 months. We used combination therapy with plasmapheresis, intravenous gamma globulin injection, tacrolimus, mycophenolate mofetil (MMF) and steroids. Plasmapheresis had been done on every other day up to 6 times to induce negative conversion of LCX. If patient continue to show positive LCX to donor after 6 times of plasmapheresis, we stopped the therapy. The numbers of plasmapheresis varies from two to six times. Kidney transplantations were preformed immediately after negative conversion of LCX as a semi-elective procedures. Five to ten day courses of ATG (or OKT3) were used as an induction immunosuppression after transplantation and tacrolimus, MMF, and steroids were used as a maintenance immunosuppression. RESULTS: We could achieve negative conversion of LCX in six out of seven patients, and kidney transplantations were performed in these 6 patients successfully. There was no hyperacute rejection during the operations, but three patients developed acute rejection episodes during their early postoperative periods. Steroid pulse therapies were used as a primary therapy to treat acute rejection and all three patients showed complete recovery of their graft function after the treatments. Baseline serum creatinine level varies from 1.0 mg/dl to 1.9 mg/dl with 3 to 6 months follow-up periods after transplantations. We could not induce negative conversion in one patient and he remained on hemodialysis. CONCLUSION: We did successful kidney transplantations in six patients who achieved negative conversion of LCX to their donors after the combination therapy with plasmapheresis and potent immunosuppression. All patients showed excellent graft function since their operations and did not have any significant complications except three reversible acute rejection episodes. According to the results, although it is preliminary, we recommend the use of the combination therapy in patient who has LCX positive living donor. Further long-term study with more numbers of patients is needed for the evaluation of the efficacy of this trial.

The Bethedsa System 2001 Workshop Report / 대한세포병리학회지

The Bethesda System (TBS) was first developed in 1988 for the need to enhance the communication of the cytopathologic findings to the referring physician in unambiguous diagnostic terms. The terminology used in this reporting system should reflect current understanding of the pathogenesis of cervical/vaginal disease, so the framework of the reporting system should be flexible enough to accommodate advances in medicine, including virology, molecular biology, and pathology. Three years after the introduction of TBS, the second Bethesda workshop was held to set or amend diagnostic criteria for each categories of TBS. TBS 1991 is now widely used. The third Bethesda workshop, The Bethesda System 2001 Workshop, was held in National Cancer Institute, Bethesda, Maryland from April 30 to May 2, 2001. Again, the goals of this workshop were to promote effective communication and to clarify in reporting cervical cytopathology results to clinicians and to provide with the information to make appropriate decisions about diagnosis and treatment. Nine forum groups were made and there were Web-based bulletin board discussions between October, 2000 and the first week of April, 2001. On the basis of bulletin board comments and discussions, the forum moderators recommended revised terminologies in the Workshop. Hot discussions were followed after the presentation by forum moderators during the workshop. Terminologies confusing clinicians and providing no additional informations regarding patient management were deleted in the workshop to clarify the cervicovaginal cytology results. Any informations related to the patient management were encouraged to add. So 'Satisfactory for evaluation but limited by' of 'Specimen Adequacy' catergory was deleted. Terminology of 'Unsatisfactory' was further specified as 'Specimen rejected' and 'Specimen processed and examined, but unsatisfactory'. Terminologies of 'Benign Cellular Change' and 'Within Normal Limits' were combined and terminology was changed to 'Negative for intraepithelial lesion

Educaçäo em enfermagem e oportunidades de carreira nos Estados Unidos da América / Nursing education and career opportunities in the USA / Educación en enfermería y oportunidades de la carrera en los Estados Unidos de la América

Esta conferência foi apresentada na Escola de Enfermagem Anna Nery em 1999, durante um Programa de visitas organizado pela EEAN e o Partners of the Americas do Rio de Janeiro. Destacaram-se a Educação em Enfermagem, oportunidades de carreira para enfermeiras e enfermeiros no Sistema de Atenção à Saúde nos E.U.A e, finalmente, a trajetória da Escola de Enfermagem da Universidade de Maryland e seus programas de graduação e pós-graduação em Enfermagem.

Comparison of the Findings of DDST (II), Brain SPECT and Brain MRI in Cerebral Palsy Children

OBJECTIVE: To evaluate the clinical values of the DDST II (Denver Developmental Screening Test, 2nd revision), 99mTc HMPAO brain single photon emission computed tomography (SPECT) findings and brain magnetic resonance imaging (MRI) in the assessment of cerebral palsy children. METHOD: Twenty-two children with cerebral palsy were investigated. Four profiles of DDST (II) were summated to a monthly age according to each developmental status. 99mTc HMPAO brain SPECT imagings were analyzed for the calculation of the perfusion defect indices. The clinical severities were scored as mild to severe, and were compared to a motor age of Maryland criteria. The presence of abnormal findings of brain MRI was also checked. RESULTS: (1) The gross and fine motor profiles of DDST (II) were significantly different between normal and abnormal findings of the brain SPECT in cerebral palsy children. (2) The region of interests ROIs in brain SPECT correlated with many profiles of DDST (II), 1) prefrontal area of the brain SPECT and language profile of DDST (II), 2) premotor area and gross motor/language profile, 3) thalamic area and social-personal profile, 4) basal ganglia area and gross motor/language proflie. respectively. (3) There was no relationship between each profile of DDST (II) and brain MRI findings. CONCLUSION: The DDST (II) and Brain SPECT seemes to be more useful than the brain MRI for the functional assessment of cerebral palsy children.