Correction of a brow ridge deformity in a comminuted depressed skull fracture using a multiple-layered pericranial flap: the Persian carpet method

Frontal sinus fractures are common traumatic injuries of the head and neck, accounting for 8% of facial fractures. When a severe frontal sinus fracture and a naso-ethmoid-orbital fracture occur together, a postoperative contour deformity is highly likely. A pericranial flap is a reliable and versatile tool for craniofacial reconstruction. The authors fabricated an anteriorly-based pericranial flap in multiple layers to camouflage the fracture site and augment the brow ridge for volumization. Open reduction and pericranial flap coverage using this method (dubbed the “Persian carpet” method) were successfully performed in a 26-year-old male patient with a comminuted frontal bone fracture and a naso-ethmoid-orbital fracture.

Correction of a brow ridge deformity in a comminuted depressed skull fracture using a multiple-layered pericranial flap: the Persian carpet method

Frontal sinus fractures are common traumatic injuries of the head and neck, accounting for 8% of facial fractures. When a severe frontal sinus fracture and a naso-ethmoid-orbital fracture occur together, a postoperative contour deformity is highly likely. A pericranial flap is a reliable and versatile tool for craniofacial reconstruction. The authors fabricated an anteriorly-based pericranial flap in multiple layers to camouflage the fracture site and augment the brow ridge for volumization. Open reduction and pericranial flap coverage using this method (dubbed the “Persian carpet” method) were successfully performed in a 26-year-old male patient with a comminuted frontal bone fracture and a naso-ethmoid-orbital fracture.

Epidemiology and Etiology of Obstructive Sleep Apnea / 대한내과학회지

Obstructive sleep apnea (OSA) is one of common sleep disorders in western countries, affecting 4% of males and 2% of females. It is characterized by repeated obstruction of the upper airway during sleep, leading to intermittent hypoxemia, sympathetic activation, and sleep fragmentation. OSA is an independent risk factor for a range of medical problems, including cardiovascular disease, diabetes, depression, and cognitive dysfunctions. The etiology of OSA is complex and incompletely understood, but recent studies have shown that the development of OSA depends on the structure of the airway anatomy, the responsiveness of the upper airway dilator muscle to stimulation, and the stability of the respiratory control system. This review details the epidemiological and experimental evidence surrounding the associations between OSA and chronic diseases. Recent findings on the etiology of OSA will also be discussed.

A Prospective Randomized Trial Comparing Divided Dose of Polyethylene Glycol Solution with Stimulant Laxative Plus Low Dose Polyethylene Glycol Solution for Colon Cleansing / 대한소화기내시경학회지

BACKGROUND/AIMS: This study compared the efficacy and patient's tolerance between those given a divided dose of a polyethylene glycol solution (PEG) and those given a stimulant laxative plus a reduced dose of PEG. METHODS: 190 consecutive patients for colon cleasing were randomized into 3 groups. In group A, 2 L of PEG was administered on the evening prior to the colonoscopy followed by 2 L of the same solution on the morning of colonoscopy. In group B, 2 L of PEG was administered in the morning only. In group C, 2 bisacodyl tablets (10 mg) were administered on the evening prior to colonoscopy and 2 L of PEG was administered in the morning. The patients completed a questionnaire to assess their tolerance to the bowel preparation before the colonoscopy. The endoscopists scored the adequacy of the bowel preparation using the Ottawa scale along with their satisfaction with the quality of the procedure. RESULTS: While 4 patients (6.7%) could not completely take the recommended dose in group A, all patients in groups B and C could take the recommended dose (p=0.012). The patients in Group B had a better tolerance and fewer side effects than those in Group A (p=0.01). A higher adequacy of bowel preparation was observed in group A than in group B (p=0.000) and there appeared to be a higher adequacy of bowel preparation in Group C than in Group B (p=0.06). CONCLUSIONS: The 2 L PEG solution only does not appear to be as effective as a bowel cleansing agent for colonoscopy compared with the divided 4 L PEG solution. No statistical difference in the side effects and efficacy was observed between the divided 4 L PEG solution and the combination of bisacodyl 10 mg with 2 L of a PEG solution.

A case of obstructive sleep apnea syndrome in childhood / 수면정신생리

The obstructive sleep apnea syndrome can occur due to various etiologies in children. In otherwise healthy children, adenotonsillar hypertrophy is the leading cause of childhood obstuctive sleep apnea. Obstructive sleep apnea caused by adenotonsillar hypertrophy can lead to a variety of symptoms and sequelae such as behavioral disturbance, enuresis, failure to thrive, developmental delay, cor pulmonale, and hypertension. So if obstructive sleep apnea is clinically suspected, proper treatment should be administered to the patient after diagnostic examinations. More than 80% improvement is seen in symptoms of obstructive sleep apnea caused by adenotonsillar hypertrophy in children after tonsillectomy and adenoidectomy. However, when it is impossible to treat the patient using surgical methods or residual symptoms remained after tonsillectomy and adenoidectomy, additional treatments such as weight control, sleep position change, and continuous positive airway pressure (CPAP), should be considered. This paper reports a case using weight control and Auto-PAP to control mild sleep apnea and snoring, which in long-term follow-up were not resolved after tonsillectomy and adenoidectomy for severe obstructive sleep apnea.

A Case of Dermatomyositis Associated with Non-Small Cell Carcinoma of The Lung / 대한류마티스학회지

Dermatomyositis is a disorder of unknown etiology characterized by an inflammatory myopathy involving striated skeletal muscle and associated characteristic skin lesions.The relationship between dermatomyositis and malignant tumor remains controversial,but we must be concerned about evaluation of suspected malignancy in a patient with dermatomyositis. We present a case of dermatomyositis associated with lung cancer.A 51-year-old male has suffered proximal muscle weakness and facial erythema for 2 months.Pathologic results showed adenocarcinoma and pneumonectomy of the left lung was performed.Myositis resolved completely after removing the malignant mass.Few cases of malignant tumors associated with dermatomyositis were reported in Korea,but dermatomyositis associated with non-small cell lung cancer and complete remission of myositis after the tumor resection has not been reported previously.

Retinal Vein Occlusion in Two Patients with Primary Antiphospholipid Syndrome

Primary antiphopholipid syndrome (APS) is a disease producing vascular thrombus with antiphospholipid antibody without association with autoimmune diseases as systemic lupus erythematosus. Retinal vein occlusion is a rare vascular manifestation in primary APS. We describe 2 cases of primary APS presenting with developing blurred vision. Each had central retinal vein occlusion and high titer of IgG anticardiolipin antibody.

A Case of spinal epidural emphysema complicating in patient with bronchial asthma / 결핵

Spinal epidural emphysema is rare, and only a few cases have ever been reported. A 18 year-old man was admitted for neck and chest pain for 3 days. Before admission he experienced rhinorrhea and severe cough. Physical examination revealed wheezing on whole lung field and subcutaneous emphysema over the upper portion of the chest and neck. Chest radiograph showed pneumomediastinum ajdn subcutaneous emphysema in the neck and chest CT images demonstrate a free air in the prevertebral fascia. With coservative management, the patient's condition and the pneumomediastinum improved. The patient was discharged to home on the fourteenth day.

Acute Pancreatitis and Distal Renal Tubular Acidosis In Sjogren's Syndrome / 대한신장학회잡지

Distal renal tubular acidosis is classified into primary and secondary. Sjogren Syndrome is the most common cause of secondary distal RTA. We experienced a 51 year-old female patient who had many manifestations of primary Sjogren syndrome which showes Distal renal tubular acidosis, acute pancreatitis, acute renal failure, possibly nephrogenic diabetes insipidus, but We found other atypical findings including ANA negative serology, high anion gap metabo1ic acidosis.

A Case of Spontaneous Regression of Spindle Cell Type Thymoma during Regular Hemodialysis / 대한신장학회잡지

A 34-year-old male who has recieved regular hemodialysis three times a week for 2years due to chronic renal failure was admitted due to chest pain. Chest x-ray and computed tomography showed large sized anterior mediastinal mass compressing heart and great vessels posteriorly. Open lung biopsy was performed and the result was spindle cell type thymoma. We recommanded surgical resection but he refused and discharged. After 8 months, we observed marked regression of the thymoma without any other treatment. We report a case of spontaneous regression of thymoma in patient with chronic renal failure during regular hemodialysis.

A Case of Behcet's Disease with Esophageal and Ileocecal Valve Ulcers / 대한소화기내시경학회지

Behcet's disease is a multisystemic, chronic inflammatory disease with a triad of symptoms including oral ulcers, genital ulcers, and inflammatory ocular lesions. While intestinal Behcet's disease commonly affects the ileocecal region, esophageal ulceration with odynophagia is very uncommon. A 38-year-old male patient was admitted due to odynophagia, a postprandial epigastric burning sensation, and right lower quadrant abdominal pain. He had a history of recurrent oral and genital ulcerations. An esophagogastroduodenoscopy revealed relatively well demarcated ulcerative lesions with mucosal nodularities on the mid to distal esophagus which was suspected to be esophageal cancer. But repeated biopsies showed lymphocytic and plasma cell infiltrations on the lamina propria. A colonoscopy revealed a well demarcated, deep ulcerative lesion with stenotic narrowing in the ileocecal valve. The diagnosis of intestinal Behcet's disease with an esophageal ulcer was made on the basis of clinical and pathological findings. The patient was treated with steroids and sulfasalazine and the response was favorable.

A case of primary pulmonary angiocentric lymphoma manifested as a mass / 결핵

The primary pulmonary lymphomas are uncommon, accounting for 0.5% of primary lung tumor and 0.4% of all malignant lymphomas. The majority of primary pulmonary lymphomas are of B-cell originating from bronchus associated lymphoid tissue(BALT). Angiocentric lymphoma is a rare type of primary pulmonary lymphomas characterized by polymorphic lymphoid infiltrates, which make it even more difficult to differentiate from benign infiltration. The radiographic findings are variable, depending on the stage of evolution of the disease. The prognosis of angiocentric lymphoma is poor, nearly two-thirds of the patients with grade 2 or 3 angiocentic lymphomas were died within a year of diagnosis. We report a case of primary pulmonary angiocentric lymphoma manifested as a mass of right lower lobe.

Unlateral Moyamoya Disease Associated with Brain Tumor

A 51-year-old female patient with right lower motor weakness and left side motor weakness is presented. MRI signal revealed a butterfly brain mass. Angiography showed stenosis of left side internal carotid artery at the supraclinoid portion and Moyamoya vessel, collateral circulation to mass via posterior circulation and contralateral was observed.

Clinical Features and Prognostic Factors of Head Injury in Less Than Two-Year-Old Children

The brain and intracranial compartment undergo a multiplicity of physiologic and anatomical changes which influence the type of head injury and response to such injury, especially for those children in first two years of age in whom development of skull and brain is still undertaking. Thus, special attention to recognize and manage these children from such injury seems mandatory. Purpose of this study is to analyze the related causes for the head injury in this age group with various clinical parameters influencing the outcome. A total of 68 children less than two years of age who were admitted to our institution after head trauma were included in this retrospective study. The causes of head injury along with other clinical settings, such as type of pathologies, Pediatric Glassgow Coma Scale(PGCS), age, operation, hypoxia, shock, seizure, anemia, abnormal pupillary response, were reviewed and clinical outcome related with these parameters were analysed. The mean duration of admission period was 15 days and mean follow-up period was 29.4 months. Most common mode of injury was stairway injury(32.3%), followed by in-car accident(19.1%), with suspected child abuse being only 2.9%. Cerebral contusion was the most frequent diagnosis being 43 cases(63.2%), followed by skull fracture in 31(45.6%). For the outcome related to various categories, 5 cases of death were due to diffuse axonal injury or intracranial hemorrhage, but most simple linear fractures were not associated with underlying brain injury. Among those required the operation(18 cases), subdural and/or epidural hematoma were the most common pathology(50%), followed by subdural hygroma and depressed skull fracture. The outcome, however, was not related to type of pathology. Instead, it was rather closely related to the initial PGCS. The PGCS at admission was found out to be the major predicting factor to outcome. In overall, 34/36(94.4%) cases with normal PGCS in these age groups showed good recovery with deaths being 5/7(71.4%) cases of PGCS