Résumé
A long nose with a drooping tip is a major aesthetic problem. It creates a negative and aged appearance and looks worse when smiling. In order to rectify this problem, the underlying anatomical causes should be understood and corrected simultaneously to optimize surgical outcomes. The causes of a drooping tip of a long nose are generally classified into two mechanisms. Static causes usually result from malposition and incorrect innate shape of the nasal structure: the nasal septum, upper and lower lateral cartilages, and the ligaments in between. The dynamic causes result from the facial expression muscles, the depressor septi nasi muscle, and the levator labii superioris alaeque nasi muscle. The depressor septi nasi depresses the nasal tip and the levator labii superioris alaeque nasi pulls the alar base upwards. Many surgical methods have been introduced, but partial approaches to correct such deformities generally do not satisfy East Asians, making the problem more challenging to surgeons. Typically, East Asians have thick nasal tip soft tissue and skin, and a depressed columella and alar bases. The authors suggest that multifactorial approaches to static and dynamic factors along with ancillary causes should be considered for correcting the drooping tip of the long noses of East Asians.
Sujets)
Humains , Asiatiques , Cartilage , Malformations , Esthétique , Expression faciale , Ligaments , Muscles , Septum nasal , Nez , Rhinoplastie , Peau , SourireRésumé
Rhinoplasty is one of the most popular surgical procedures in plastic surgeries. Good results depend not only on the surgical technique but also on individual preference and philosophy of the surgeons. This article reports on the survey of the attitude, preference, and philosophy of surgeons, and finally to elicit the evidence based consensus of current trends mainly dealing with the primary rhinoplasty. The Korean Society of Rhinoplasty Surgeons(KSRS) prepared a questionnaire composed of 20 questions asking about the primary esthetic rhinoplasty. A total of 77 out of 450 plastic surgeons attending the rhinoplasty symposium, 2009, Korea replied and the answerswere assessed. Twenty questions were about operation techniques, preference of alloplastic implant, autologous materials and trivia about the complications rates, etc. Many plastic surgeons preferred silicone to Gore-tex(R). In cases of autologous cartilage grafts, experienced plastic surgeons were more likely to use septal cartilage. But generally, ear cartilages were more frequently used when it is concomitantly used with alloplastic implants. Among silicone implants, boat-shape implant was preferred to L-shape regardless of their surgical experiences. Many Korean plastic surgeons prefer open rhinoplasty to closed rhinoplasty and routinely use boat shape silicone with auricular cartilage when they are doing simple primary rhinoplasty.
Sujets)
Cartilage , Consensus , Cartilage de l'oreille , Corée , Philosophie , Rhinoplastie , Navires , Silicone , Transplants , Enquêtes et questionnairesRésumé
Preadipocyte cell lines are useful models for investigating adipogenesis process. 3T3-L1 preadipocyte, which can be induced to differentiate into adipocyte in cell culture, is one of the most studied preadipocyte cell lines. When exposed to the appropriate differentiation inducer, including insulin, dexamethasone and 3-isobutyl- 1-methylxanthine, 3T3-L1 preadipocytes differentiate into adipocytes. This study was undertaken to evaluate the effect of epigallocatechin on differentiation of 3T3-L1 preadipocyte, and to test whether epigallocatechin can be useful to reduce fat deposition. Cell proliferation was determined by MTT(3,4,5-Dimethylthiazol-2,5-Diphenyl- Tetrazoliumbromide) spectro-photometry, fat content followed by cell differentiation was determined by Oil Red O staining, and the degree of differentiation into adipocytes were determined by measuring mRNA content and activity of glyceraldehydes 3-phosphate dehydrogenase (G3PDH). Epigallocatechin inhibited proliferation of preadipocytes, not into adipocytes. Fat storage during 3T3-L1 preadipocyte conversion into adipocyte was inhibited by epigallocathechin. Epigallocatechin decreased G3PDH, leptin mRNA and peroxisome proliferator-activated receptor(PPAR)gamma mRNA which were increased by differentiation of preadipocyte into adipocyte. These results suggest that epigallocatechin has a potential to serve as a fat-reducing drug.
Sujets)
Adipocytes , Adipogenèse , Techniques de culture cellulaire , Différenciation cellulaire , Lignée cellulaire , Prolifération cellulaire , Dexaméthasone , Insuline , Leptine , Oxidoreductases , Péroxysomes , ARN messagerRésumé
Scalp avulsion is rare injury that has serious consequences, including hospitalization, economic loss, devasting disfigurement, and psychological effects on the patient. Microvascular surgery now allows an initial chance for successful replantation and one-stage reconstruction. The need for secondary reconstructive procedures after a successful replantation is minimal. Our one year experience with 2 patients who suffered from avulsion of partial scalp is reviewed. Each patient got long hair entangled in the uncovered rotated machines and underwent replantation using microsurgical technique. Replantations have been accomplished using only arterio-venous and venous-venous anastomosis, without arterio-arterial anastomosis in 2 cases, because of unidentification of suitable arteries. The possible explanation for the success of the operation is the paucity of valves that exist in the venous network of the scalp and forehead. The final results were good. In the follow-up period, both experienced regrowth of hair in the scalp with light touch sensation.
Sujets)
Humains , Artères , Études de suivi , Front , Poils , Hospitalisation , Réimplantation , Cuir chevelu , SensationRésumé
Blepharoptosis following pterigium excision is a rare complication, and there is no published report on its etiology, incidence, and surgical pathology. We report 4 cases of persistant blepharoptosis following pterigium surgery. The main clinical features are high or absent upper lid crease, thinning of ptotic eyelid above tarsal plate, good levator function, 2-3mm of ptosis degree, abnormal drooping of upper eyelid at downward gaze, and deepening of the upper sulcus. They have a specific anatomic defect in the aponeurosis of levator palpebrae superioris(LPS) muscle. It has been assumed that eyelid speculum leads to injury of upper border of tarsal plate and disinsertion of aponeurosis of LPS muscle in the patient who had vulnerable aponeurosis of LPS muscle during surgery. Disinsertion of aponeurosis of LPS muscle from its epitarsal attachment was discovered during blepharotosis surgery and it was repaired anatomically to correct the blepharoptosis.
Sujets)
Humains , Blépharoptose , Paupières , Incidence , Anatomopathologie chirurgicale , Ptérygion , Instruments chirurgicauxRésumé
Chromomycosis is a chronic mycosis of the skin and subcutaneous tissue characterized by a brown, thick-walled, round, nonbudding form of causative fungi in the tissue. We report a case of chromomycosis caused by Fonsecaea pedrosoi in a 56-year-old Korean woman who showed 3 x 4cm sized deep ulcerations on the dorsa of both hands. Histopathologically, chronic granulomatous inflammation and sclerotic cells were observed. Fonsecaea pedrosoi was grown into typical black colonies in fungus culture. She was treated with pedicle flap graft followed by oral itraconazole, and showed clinical improvement.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Chromoblastomycose , Champignons , Main , Inflammation , Itraconazole , Peau , Tissu sous-cutané , Transplants , UlcèreRésumé
The purpose of this study is to investigate the effect of nerve regeneration to island flap vascularity after crushing injury to pedicle nerve. A total of 40 adult male Sprague Dawley rats (200-250 gm) were used and divided into 4 groups (n = 10). Two inferior epigastric island flaps were elevated including panniculus carnosus on each rat: one retained innervation (control); the other was denervation by crushing injury to superficial epigastric nerve. After the flap elevation, vascularity of the flap was checked by laser doppler at superficial epigastric artery. Group 1 was vascularity of the flap after 1 day, group 2 after 3days, group 3 after 5 days, group 4 after 7 days. Under light and electron microscope, histologic changes were compared. In conclusion, our experimental study proved that vascularity of the epigastric island flap was slowly decreased with histologic findings of nerve regeneration. Denervated flap had more vascularity than other groups by 7 days. This study appears to be a valid one which treatment and post operative care of very small island flap such as distal finger tip amputation (Zone I level).
Sujets)
Adulte , Animaux , Humains , Mâle , Rats , Amputation chirurgicale , Dénervation , Artères épigastriques , Doigts , Régénération nerveuse , Rat Sprague-Dawley , Lambeaux chirurgicauxRésumé
The authors reported a case and its diagnostic process of post-traumatic narcolepsy which had developed after a head trauma. The 51-years-old patient showed frequent generalized paralytic attack, which was aggravated during stressful situation, diet time, and in front of hospital staffs. During the paralytic attack, consciousness was alert, and he never collapsed to hurt. All laboratory findings including serum potassium level were within normal limit, and also brain imaging studies and electroencephalography revealed no specific abnormal findings. Our clinical impression was a conversion disorder or a malingering at first, but after the detailed history taking and the careful observation, daytime sleep attack and some sleep problems were revealed. Thus nocturnal polysomnography and multiple sleep latency test(MSLT) were performed, and then the authors could diagnose as "narcolepsy". HLA-DR2 typing was negative. After imipramine trial, the frequency and the intensity of attack was dramatically reduced. The authors concluded that narcolepsy should be considered in the differential diagnosis of sleepiness or transient loss of muscle tone after traumatic brain injury.
Sujets)
Humains , Lésions encéphaliques , Cataplexie , Conscience , Trouble de conversion , Traumatismes cranioencéphaliques , Diagnostic différentiel , Régime alimentaire , Électroencéphalographie , Antigène HLA-DR2 , Imipramine , Simulation , Narcolepsie , Neuroimagerie , Polysomnographie , PotassiumRésumé
No abstract available.
Résumé
End-to-side neurorrhaphy had been firstly reported at the beginning of this century, but no further clinical reports have been released. In some cases of end-to-end neurorrhaphy, donor nerve incision or even sacrification is inevitably necessary. In doing end-to-side neurorrhaphy, has not been widely accepted because previous results were not satisfactory. The purpose of this study is to evaluate the applicability of end-to-side neurorrhaphy in rats. Twenty female Sprague-Dawley rats, weighing approximately 200-250 g(232.50+/-12.6g) were used. In 10 rats, their right and left peroneal nerves were cut and the distal end of peroneal nerves were end-to-side neurorrhaphied to the tibial nerve. On the right side, the epineurium was left intact and on the left side, it was removed. The proximal end of peroneal nerves were imbedded in the thigh muscle. After 6 months, eletrophysiologic tests, including nerve conduction velocity, the amplitude and the areas of action potential of the tibial cranial muscle were done and then all rats were sacrificed for histologic analysis. The other 10 offspring rats were raised and used for control group. The mean weight of the tibial cranial muscle was 1.74(+/-0.30)g on the right side, 1.54(+/-0.31)g on the left side and 1.97(+/-0.28)g in the control group, which was statistically not significant. The number of muscle fibers in x 100 magnification was 106.10(+/-4.28) on the right side, 109.67(+/-4.69) on the left side and 107.80(+/-4.64) in the control group, which was also not significant. The amplitude and width of muscle action potential were not statistically different among the right side, the left side and in the control group. However, the nerve conduction velocity was bilaterally delayed if compared to control group. In histologic analysis, the presence of epineurium did not impact the results and end-to-side neurorrhaphy were successfully regenerated in all rats. End-to-side neurorrhaphy seem to be a functionally and histologically tolerable alternative when end-to-end neurorrhaphy is not available.
Sujets)
Animaux , Femelle , Humains , Rats , Potentiels d'action , Régénération nerveuse , Conduction nerveuse , Nerfs périphériques , Nerf fibulaire commun , Rat Sprague-Dawley , Cuisse , Nerf tibial , Donneurs de tissusRésumé
OBJECTIVES: Drug compliance is the most important issue in long-term treatment outcome and prognosis of manic patients. Up to date, there has been no study about drug compliance at the point of the first manic episode and subsequent maintenance period. And also there are limited data regarding the rates of noncompliance in patients with bipolar disorder and schizoaffective disorder in Korea. So the author studied about the rate of noncompliance in manic patients and about the clinical predicting factors associated with their drug compliance. METHODS: Compliance of a patient was assessed by patient's report, family member's report, treater's estimation, investigator-administered questionnaire, record of unkept appointment and plasma concentration of mood-stabilizer. Data about patient-related, illness-related and treatment-related factors of compliance were collected by the review of medical records and interview with the patient. RESULTS: Forty patients (56.3%)were noncompliant with their pharmacologic regimen at the point of the first treatment period. Noncompliance was significantly associated with experience of childhood stressful life events(p=.035) presence of psychotic symptoms(p=.020)and treatment with combination of mood-stabilizers(p=.002) CONCLUSION: Patients who experienced serious life event in their childhood, had delusion or hallucination during the manic episode, or received the combination therapy of mood-stabilizer are prone to fail in treatment adherence.