Prevalence and Alternative Treatment of Head-Lice Infestation in Rural Thailand: A Community-Based Study

Head-lice infestation, pediculosis capitis, remains a public-health burden in many countries. The widely used first-line pediculicides and alternative treatments are often too costly for use in poor socio-economic settings. Ivermectin has been considered an alternate treatment for field practice. This study was composed of 2 parts, a cross-sectional survey and an intervention study. The main objectives were to determine the prevalence and potential factors associated with head-lice infestation, and to evaluate the effectiveness and safety of oral ivermectin administration. A community-based cross-sectional survey was conducted among 890 villagers in rural areas along Thai-Myanmar border. Females with infestations were eligible for the intervention study, and 181 participated in the intervention study. A post-treatment survey was conducted to assess acceptance of ivermectin as a treatment choice. Data analysis used descriptive statistics and a generalized-estimation-equation model adjusted for cluster effect. The study revealed the prevalence of head-lice infestation was 50% among females and only 3% among males. Age stratification showed a high prevalence among females aged <20 years, and among 50% of female school-children. The prevalence was persistent among those with a history of infestation. The major risk factors were residing in a setting with other infected cases, and sharing a hair comb. The study also confirmed that ivermectin was safe and effective for field-based practice. It was considered a preferable treatment option. In conclusion, behavior-change communication should be implemented to reduce the observed high prevalence of head-lice infestation. Ivermectin may be an alternative choice for head-lice treatment, especially in remote areas.

Echinochasmus caninus n. comb. (Trematoda: Echinostomatidae) Infection in Eleven Riparian People in Khammouane Province, Lao PDR

Adult specimens of Echinochasmus caninus n. comb. (Verma, 1935) (Trematoda: Echinostomatidae) (syn. Episthmium caninum Yamaguti, 1958) were recovered from 11 riparian people who resided along the Mekong River in Khammouane Province, Lao PDR. In fecal examinations done by the Kato-Katz technique, the cases revealed eggs of Opisthorchis viverrini/minute intestinal flukes, hookworms, and in 2 cases echinostome eggs. To recover the adult helminths, praziquantel 30–40 mg/kg and pyrantel pamoate 10–15 mg/kg in a single dose were given and purged with magnesium salts. Various species of trematodes (including O. viverrini and Haplorchis spp.), cestodes, and nematodes were recovered from their diarrheic stools. Among the trematodes, small echinostome flukes (n=42; av. 3.8 specimens per case) of 0.7–1.2 mm in length are subjected in this study. They are morphologically characterized by having 24 collar spines interrupted dorsally and anterior extension of vitellaria from the cirrus sac or genital pore level to the posterior end of the body. Particularly based on this extensive distribution of vitellaria, the specific diagnosis was made as Echinochasmus caninus. The cases were co-infected with various other helminth parasites; thus, clinical manifestations specific for this echinostome infection were difficult to determine. The present paper describes for the first time human E. caninus infections in Lao PDR. Our cases marked the 4–14th human infections with this echinostome around the world following the 3 previous cases reported from Thailand.

Taxonomy of the Golovinomyces cynoglossi Complex (Erysiphales, Ascomycota) Disentangled by Phylogenetic Analyses and Reassessments of Morphological Traits

The name Golovinomyces cynoglossi s. lat. is traditionally applied to a complex of morphologically similar powdery mildews on hosts of the plant family Boraginaceae. The current species-level taxonomy within this complex is ambiguous due to the lack of phylogenetic examinations. The present study applied phylogenetic methods to clarify the taxonomy of G. cynoglossi s. lat. Phylogenetic analysis of rDNA ITS sequences retrieved from Asian, European and North American specimens revealed that G. cynoglossi s. lat. collections from different hosts involved several species in five clearly separated lineages. Clade I consists primarily of Golovinomyces cynoglossi s. str. on Cynoglossum. Clade III consists of Golovinomyces sequences retrieved from the host genera Symphytum and Pulmonaria. The taxa within clade III are now assigned to G. asperifoliorum comb. nov. Clade V encompasses G. cynoglossi s. lat. on the host genera Bothriospermum, Buglossoides, Echium, Myosotis, and Trigonotis. The taxa within clade V are now assigned to G. asperifolii comb. nov. The species concerned in this study were lecto- and epitypified to stabilize their nomenclature.

Extracorporeal Therapy as a Treatment Method in Patients with Acute Ethylene Glycol Poisoning

PURPOSE: Extracorporeal treatment has been used increasingly to treat patients with acute ethylene glycol poisoning. We analyzed all patients with acute poisoning of ethylene glycol during a recent 10-year period to provide clinical recommendations for adequate application of continuous renal replacement therapy for these patients. METHODS: A retrospective chart review study was conducted for patients whose final diagnosis were “toxic effects of glycols or other alcohols,” between October 2006 and September 2016. The basal characteristics of patients, suspected amount of ingestion, intention of poisoning, concomitant alcohol ingestion, mental state at admission, time from exposure to admission, chief complaint, length of hospital stay, method of treatments, laboratory results including acute kidney injury and urine oxalate crystal, as well as treatment results were examined. RESULTS: A total number of 14 patients were included in this study. Nine patients (64.3%) underwent continuous renal replacement therapy; 5 patients (35.7%) underwent ethanol mono-therapy. Between the antidote therapy group and the extracorporeal treatment group, there was a significant difference in the levels of plasma bicarbonate, chloride, anion gap, pH, and base excess in arterial blood gas analysis, as well as the calculated osmolar gap. One patient expired due to multi-organ failure, while the others recovered completely. CONCLUSION: Continuous renal replacement therapy was most frequently chosen as a treatment method in patients with acute ethylene glycol poisoning. Further research regarding indication of continuous renal replacement therapy and combing therapy with other treatment will be necessary to determine the best treatment method.

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

Abdominal computed tomography (CT) can noninvasively image the entire gastrointestinal tract and assess extraintestinal features that are important in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). The present meta-analysis pooled the results of all studies on the role of CT abdomen in differentiating between CD and ITB. We searched PubMed and Embase for all publications in English that analyzed the features differentiating between CD and ITB on abdominal CT. The features included comb sign, necrotic lymph nodes, asymmetric bowel wall thickening, skip lesions, fibrofatty proliferation, mural stratification, ileocaecal area, long segment, and left colonic involvements. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated for all the features. Symmetric receiver operating characteristic curve was plotted for features present in >3 studies. Heterogeneity and publication bias was assessed and sensitivity analysis was performed by excluding studies that compared features on conventional abdominal CT instead of CT enterography (CTE). We included 6 studies (4 CTE, 1 conventional abdominal CT, and 1 CTE+conventional abdominal CT) involving 417 and 195 patients with CD and ITB, respectively. Necrotic lymph nodes had the highest diagnostic accuracy (sensitivity, 23%; specificity, 100%; DOR, 30.2) for ITB diagnosis, and comb sign (sensitivity, 82%; specificity, 81%; DOR, 21.5) followed by skip lesions (sensitivity, 86%; specificity, 74%; DOR, 16.5) had the highest diagnostic accuracy for CD diagnosis. On sensitivity analysis, the diagnostic accuracy of other features excluding asymmetric bowel wall thickening remained similar. Necrotic lymph nodes and comb sign on abdominal CT had the best diagnostic accuracy in differentiating CD and ITB.

Evaluation of Related Risk Factors in Number of Musculoskeletal Disorders Among Carpet Weavers in Iran

BACKGROUND: Musculoskeletal disorders (MSDs) are a common problem among carpet weavers. This study was undertaken to introduce affecting personal and occupational factors in developing the number of MSDs among carpet weavers. METHODS: A cross-sectional study was performed among 862 weavers in seven towns with regard to workhouse location in urban or rural regions. Data were collected by using questionnaires that contain personal, workplace, and information tools and the modified Nordic MSDs questionnaire. Statistical analysis was performed by applying Poisson and negative binomial mixed models using a full Bayesian hierarchical approach. The deviance information criterion was used for comparison between models and model selection. RESULTS: The majority of weavers (72%) were female and carpet weaving was the main job of 85.2% of workers. The negative binomial mixed model with lowest deviance information criterion was selected as the best model. The criteria showed the convergence of chains. Based on 95% Bayesian credible interval, the main job and weaving type variables statistically affected the number of MSDs, but variables age, sex, weaving comb, work experience, and carpet weaving looms were not significant. CONCLUSION: According to the results of this study, it can be concluded that occupational factors are associated with the number of MSDs developing among carpet weavers. Thus, using standard tools and decreasing hours of work per day can reduce frequency of MSDs among carpet weavers.

Magnetic resonance enterography for the evaluation of the deep small intestine in Crohn's disease

For the control of Crohn's disease (CD) a thorough assessment of the small intestine is essential; several modalities may be utilized, with cross-sectional imaging being important. Magnetic resonance (MR) enterography, i.e., MRE is recommended as a modality with the highest accuracy for CD lesions. MRE and MR enteroclysis are the two methods performed following distension of the small intestine. MRE has sensitivity and specificity comparable to computed tomography enterography (CTE); although images obtained using MRE are less clear compared with CTE, MRE does not expose the patient to radiation and is superior for soft-tissue contrast. Furthermore, it can assess not only static but also dynamic and functional imaging and reveals signs of CD, such as abscess, comb sign, fat edema, fistula, lymph node enhancement, less motility, mucosal lesions, stricture, and wall enhancement. Several indices of inflammatory changes and intestinal damage have been proposed for objective evaluation. Recently, diffusion-weighted imaging has been proposed, which does not need bowel preparation and contrast enhancement. Comprehension of the characteristics of MRE and other modalities is important for better management of CD.

Effect of microneedle combined with Lauromacrogol on skin capillary network: experimental study / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the effect of microneedle combined with Lauromacrogol on skin capillary network.</p><p><b>METHODS</b>24 male Leghone (1.5-2.0 kg in weight) were randomly divided into three groups as group A (microneedle combined with Lauromacrogol), B (microneedle combined with physiological saline) , and C(control). The cockscombs were treated. The specimens were taken on the 7th, 14th, 21th , and 28th day postoperatively. HE staining, immunohistochemical staining and special staining were performed for study of the number of capillary and collagen I/III , as well as elastic fibers.</p><p><b>RESULTS</b>The color of cockscombs in group A became lightening after treatment. The number of capillary decreased as showing by HE staining. The collagen I and III in group B was significantly different from that in group A and C (P < 0.05). Special staining showed proliferation of elastic fibers in group B.</p><p><b>CONCLUSIONS</b>It indicates that microneedle combined with Lauromacrogol could effectively reduce the capillary in cockscomb without any tissue fibrosis. Microneedle can stimulate the proliferation of elastic fiber, so as to improve the skin ageing process.</p>

Sedation using 5% lidocaine patches, midazolam and propofol in a combative, obese adolescent with severe autistic disorder undergoing brain magnetic resonance imaging: a case report / 대한마취과학회지

We present a 17-year-old man who underwent brain magnetic resonance imaging and laboratory exams for uncontrolled seizure. Patients with an autistic disorder require deep sedation or, occasionally, general anesthesia even for radiologic exams or simple procedures. The anesthetic management of an obese, violent patient with a severe autistic disorder and mental retardation can be challenging to anesthesiologists and requires a more careful approach in selecting adequate anesthetics and doses. This case emphasizes the importance of having a detailed plan to ensure the smooth process of premedication, anesthetic induction, maintenance, emergence and safe discharge of incorporated patients in the event of unexpected situations. A 5% lidocaine patch to relieve the pain from the intramuscular injection and intravenous cannulation, intramuscular midazolam as premedication, and propofol for the maintenance of sedation can be a good sedation protocol in incorporated patients.

Computed Tomography Enterography for Evaluation of Inflammatory Bowel Disease

Computed tomography enterography (CTE) has become a main modality for the evaluation of inflammatory bowel disease (IBD). It simultaneously offers visualization of the small bowel and extraintestinal status, which is helpful for diagnosing IBD. Crohn disease has long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric vascularity and internal/perianal fistula are characteristics of Crohn disease and can be identified on CTE. Short segmental inflammatory wall thickening and the central low attenuated lymph nodes are favorable CT finding of intestinal tuberculosis. A geographic, relatively large, and deep penetrating ulcer with bowel wall thickening and mural hyperenhancement in ileocecal area are characteristics of intestinal Behcet disease. Each of CTE findings for the IBDs is helpful for differential diagnosis. The main disadvantage of this technique is the requisite radiation exposure of patients, particularly in young patients. However, recent development of advanced CT techniques is promising for radiation dose reduction without compromising diagnostic image quality.

Sensitization of the Trigeminovascular Pathway: Perspective and Implications to Migraine Pathophysiology

Migraine headache is commonly associated with signs of exaggerated intracranial and extracranial mechanical sensitivities. Patients exhibiting signs of intracranial hypersensitivity testify that their headache throbs and that mundane physical activities that increase intracranial pressure (such as bending over or coughing) intensify the pain. Patients exhibiting signs of extracranial hypersensitivity testify that during migraine their facial skin hurts in response to otherwise innocuous activities such as combing, shaving, letting water run over their face in the shower, or wearing glasses or earrings (termed here cephalic cutaneous allodynia). Such patients often testify that during migraine their bodily skin is hypersensitive and that wearing tight cloth, bracelets, rings, necklaces and socks or using a heavy blanket can be uncomfortable and/or painful (termed her extracephalic cutaneous allodynia). This review summarizes the evidence that support the view that activation of the trigeminovascular pathway contribute to the headache phase of a migraine attack, that the development of throbbing in the initial phase of migraine is mediated by sensitization of peripheral trigeminovascular neurons that innervate the meninges, that the development of cephalic allodynia is propelled by sensitization of second-order trigeminovascular neurons in the spinal trigeminal nucleus which receive converging sensory input from the meninges as well as from the scalp and facial skin, and that the development of extracephalic allodynia is mediated by sensitization of third-order trigeminovascular neurons in the posterior thalamic nuclei which receive converging sensory input from the meninges, facial and body skin.

A Study of Optimized MRI Parameters for Polymer Gel Dosimetry / 의학물리

In order to verify exact dose distributions in the state-of-the-art radiation techniques, a newly designed three-dimensional dosimeter and technique has been took strongly into consideration. The main purpose of our study is to verify the optimized parameters of polymer gel as a real volumetric dosimeter in terms of the various study of MRI. We prepared a gel dosimeter by combing 8% of gelatin, 8% of MAA, and 10 mM of THPC. We used a Co-60 gamma-ray teletherapy unit and delivered doses of 0, 2, 4, 6, 8, 10, 12, and 14 Gy to each polymer gel with a solid phantom. We used a fast spin-echo pulse to acquire the characterized T2 time of MRI. The signal noise ratio (SNR) of the head & neck coil was a relatively lower sensitivity than the body coil; therefore the dose uncertainty of head & neck coil would be lower than body coil's. But the dose uncertainty and resolution of the head & neck coil were superior to the body coil in this study. The TR time between 1,500 ms and 2,000 ms showed no significant difference in the dose resolution, but TR of 1,500 ms showed less dose uncertainty. For the slice thickness of 2.5 mm, less dose uncertainty of TE times was at 4 Gy, as well, it was the lowest result over 4 Gy at TE of 12 ms. The dose uncertainty was not critical up to 6 Gy, but the best dose resolution was obtained at 20 ms up to 8 Gy. The dose resolution shows the lowest value was over 20 ms and was an excellent result in the number of excitation (NEX) of three. The NEX of two was the highest dose resolution. We concluded that the better result of slice thickness versus NEX was related to the NEX increment and thin slice thickness.

Intravitreal Bevacizumab With or Without Photodynamic Therapy for the Treatment of Polypoidal Choroidal Vasculopathy

PURPOSE: To compare the efficacy of photodynamic therapy (PDT) using verteporfin combined with intravitreal bevacizumab and bevacizumab monotherapy in polypoidal choroidal vasculopathy (PCV). METHODS: Twenty-six eyes, diagnosed with PCV were reviewed retrospectively. They were divided into two groups: combined treatment (COMB) and bevacizumab monotherapy (BEV). Visual acuity, fluorescein angiography (FA) and indocyanine green angiography (ICG) results were reviewed to compare changes in the polypoidal vessels and the branching vascular networks. RESULTS: Among 26 eyes of 26 patients, there were 12 eyes in the COMB group and 14 eyes in the BEV group. Follow-up periods were about 42 weeks and 48 weeks for the respective groups. In the COMB group, visual acuity improved from log MAR 0.92 to 0.56, whereas visual acuity in the BEV group changed only minimally from log MAR 0.98 to 0.97. In the COMB group, the polypoidal vessel resolved in six eyes. In the BEV group, the polypoidal vessel resolved in one eye. In the COMB group, the vascular network resolved in one eye, improved in ten eyes, and did not change in one eye. In the BEV group, the vascular network did not change in any of the 14 eyes. CONCLUSIONS: Combined treatment with PDT and intravitreal bevacizumab resulted in a more prolonged effect, induced the resolution of polypoidal vessels more effectively than did bevacizumab monotherapy, and is expected to reduce recurrence and retreatment.

In Vitro Enhancement of Radiosensitivity by the Combination of Celecoxib and Ad-mda7 in Human Breast Cancer Cells / 한국유방암학회지

PURPOSE: Celecoxib and Ad-mda7 have shown its ability to enhance radiosensitivity in various cancer cells in vitro. We expected to synergistically enhance radiosensitivity by combing celecoxib and Ad-mda7 in breast cancer cells in vitro. METHODS: MDA-MB-436 and MDA-MB-468 human breast cancer cells were exposed to different doses (0, 2, 4, and 6 Gy) of radiation with or without pretreatment with either Ad-mda7 or celecoxib alone, or with the combination for three days prior to irradiation. Clonogenic cell survival assay was used to compare the radiosensitizing effect. Fluorescence activated cell sorting analysis was performed to assess cell cycle changes and the subdiploid cell population. We determined the prostaglandin E2 (PGE2) concentration before and after the irradiation (2 Gy, 24 hours). We performed western blot analysis of Akt, phosphorylated Akt, beta-catenin, and cyclooxygenase-2 (COX-2). RESULTS: At the sublethal dose of celecoxib and Ad-mda7, the combination showed significantly enhanced radiosensitivity. The enhancement factor for the combination treatment was 1.44 in MDA-MB-468 cells and 1.75 in MDA-MB-436 cells. There were an increased percentage of apoptotic cells in the combination therapy group as compared to the controls, but this was not statistically significant. Cell cycle analysis demonstrated an increase in the G2/M phase of the cell cycle in the combination group compared with controls. The concentration of PGE2 was significantly decreased after the irradiation in both cell lines compared to the controls. Western blot analysis confirmed that this combination treatment effectively suppress the expression of Akt, phosphorylated Akt, and COX-2 in those cell lines, except beta-catenin. CONCLUSION: Cotreatment of Ad-mda7 plus celecoxib definitely showed radioenhancing effect. We presumed that this effect may be the arrest of the cells at the radiosensitive G2/M phase of the cell cycle.

Effects of Short Term Antioxidant Cocktail Supplementation on the Oxidative Stress and Inflammatory Response of Renal Inflammation in Diabetic Mice

Diabetes mellitus is a multifactorial disease. Particularly, diabetic nephropathy is a serious complication for diabetic patients, yet the precise mechanisms that underline the initial stage of diabetic renal inflammation remain unknown. However, oxidative stress induced by hyperglycemia in diabetes is implicated in diabetic renal disease. We hypothesized that dietary supplementation of antioxidants either VCE (0.5% VC + 0.5% VE) or Comb (0.5% VC + 0.5% VE + 2.5% N-acetylcysteine) improves acute diabetic renal inflammation through modulation of blood glucose levels and antioxidant and anti-inflammatory responses. Experimental animals (5.5 weeks old female ICR) used were treated with alloxan (180 mg/kg) once. When fasting blood glucose levels were higher than 250 mg/dL, mice were divided into 3 groups fed different levels of antioxidant supplementation, DM (diabetic mice fed AIN 93G purified rodent diet); VCE (diabetic mice fed 0.5% vitamin C and 0.5% vitamin E supplemented diet); Comb (diabetic mice fed 0.5% vitamin C, 0.5% vitamin E and 2.5% N-acetylcysteine supplemented diet), for 10 days and then sacrificed. Body weights were measured once a week and blood glucose levels were monitored twice a week. Lipid peroxidation products, thiobarbituric acid reacting substances were measured in kidney. NF-kappaB activation was indirectly demonstrated by pIkappaB-alpha and expressions of selective inflammatory and oxidative stress markers including antioxidant enzymes were also determined. Dietary antioxidant supplementation improved levels of blood glucose as well as kidney lipid peroxi-dation. Dietary antioxidant supplementation improved NF-kappaB activation and protein expression of HO-1, but not mRNA expression levels in diabetic mice fed Comb diet. In contrast, the mRNA and protein expression of CuZnSOD was decreased in diabetic mice fed Comb diet. However, antioxidant supplementation did not improve mRNA and protein expressions of IL-1beta and MnSOD in diabetic mice. These findings demonstrate that acute diabetic renal inflammation was associated with altered inflammatory and antioxidant responses and suggest that antioxidant cocktail supplementation may have beneficial effects on early stage of diabetic nephropathy through modulation of blood glucose levels and antioxidant enzyme expressions.

A Case of Accessory Tragus on the Posterior Neck / 대한피부과학회지

Cervical accessory tragus is a rare congenital malformation presenting at birth as a firm nodule on the neck along the anterior edge of the sternocleidomastoid muscle. It has also been reported under different names, such as elastic cartilage choristoma of the neck, Meckel's cartilaginous remnant, cervical tab, cervical auricle, and wattle. Histologically, cervical accessory tragus is composed of numerous hair follicles, and a prominent connective tissue framework in the subcutaneous fat and central core of cartilage. We report a case of an 8-year-old female who presented with a solitary flesh colored papule on the posterior neck that was histopathologically diagnosed as cervical accessory tragus.

A Case of Accessory Tragus on the Posterior Neck / 대한피부과학회지

Cervical accessory tragus is a rare congenital malformation presenting at birth as a firm nodule on the neck along the anterior edge of the sternocleidomastoid muscle. It has also been reported under different names, such as elastic cartilage choristoma of the neck, Meckel's cartilaginous remnant, cervical tab, cervical auricle, and wattle. Histologically, cervical accessory tragus is composed of numerous hair follicles, and a prominent connective tissue framework in the subcutaneous fat and central core of cartilage. We report a case of an 8-year-old female who presented with a solitary flesh colored papule on the posterior neck that was histopathologically diagnosed as cervical accessory tragus.

Micromorphometric change of implant surface conditioned with Tetracycline-HCl: HA and Etched surface / 대한치주과학회지

The present study was performed to evaluate the effect of tetracycline-HCl on the change of implant surface microstructure according to application time. Implant with pure titanium machined surface, HA-coated surface and dual acid etched surface were utilized. Implant surface was rubbed with 50mg/ml tetracycline-HCL solution for 1/2min., 1min., 1 1/2min., 2min., and 2 1/2min. respectively in the test group. Then, specimens were processed for scanning electron microscopic observation. The results of this study were as follows. 1. Both test and control group showed a few shallow grooves and ridges in pure titanium machined surface implants. There were not significant differences between two groups. 2. In HA-coated surfaces, round particles were deposited irregularly. The roughness of surfaces conditioned with tetracycline-HCL was lessened and the cracks were increased relative to the application time. 3. The etched surfaces showed the honey comb structures. The surface conditioning with tetracycline-HCl didn't influence on its micro-morphology. In conclusion, the detoxification with 50mg/ml tetracycline-HCl must be applied respectively with different time according to various implant surfaces.

Stepped Subciliary Skin Muscle Flap Versus Nonstepped Subciliary Skin Muscle Flap for Orbital or Zygomatic Fractures

Malposition of the lower eyelid is probably the most important following lower eyelid incision for orbital or zygomatic fracture repair. Its severity may range from increased scleral show to gross ectropion. There are two major determinants of lower eyelid position after surgery: the integrity of the tarsus, canthal ligaments, and pretarsal orbicularis and cicatrical forces within the skin, orbital septum, and capsulopalpebral fascia. A total of two hundreds and six patients were investigated for functional and aesthetic impairments following treatment of orbital or zygomatic fracture through stepped subciliary skin muscle flap or nonstepped subciliary skin muscle flap and periosteal repair. As a result, the incidence of scleral show, ectropion was reduced with statistical significance after stepped subciliary skin muscle flap and periosteal repair of infraorbital rim than nonstepped subciliary skin muscle flap incision and no periosteal repair. The reason is that stepped subciliary skin muscle flap has following characteristics than nonstepped subciliary skin muscle flap: Enough of the muscle must be left to allow for its normal contraction capacity and permit an adequate support of the palpebral rim. In addition, the remaining muscular volume in the tarsal portion, near the lashes, will be sufficient to maintain the lid tonicity. Also, repair of periosteum provides firm fixation of soft tissue to infraorbital rim and prevent hematoma due to decreased dead space. By combing the stepped subciliary skin muscle flap with periosteal repair of infraorbital rim for orbital or zygomatic fracture repair, it is expeced that complications will be reduced such as scar contracture, scleral show and ectropion.

Revision Total Elbow Arthroplasty Using Strut Allograft: Two Cases Report / 대한정형외과학회잡지

We describe the allograft technique and present its final results of revision total elbow arthroplasty (TEA) using a strut allograft in two cases that revealed prosthetic loosening and severe bone resorption after TEA. Two patients complained of pain and motion limitation, and had difficulty in hair combing and with hygiene. The preoperative Mayo elbow performance scores of both cases were 50 points and 45 points. They were followed up for 24 months and 18 months. There was no pain after surgery and the postoperative Mayo elbow performance scores were all 90 points. Radiographic bone unions were achieved 3 months after the operations and patients were satisfied with the results. The revision of TEA with a supporting allograft is a demanding procedure but can be tried when the elbow joint has badly destructed or has a large cavitary defect.