Hallazgos en tomografía computada de las complicaciones de la pancreatitis aguda / Findings of Acute Pancreatitis Complications on CT

Resumen La pancreatitis aguda es una patología inflamatoria del páncreas que se caracteriza por dolor abdominal y elevación de los niveles séricos de amilasa. Desde el punto de vista imagenológico, se la estudia con tomografía computada (TC), siendo esa la modalidad de elección para evaluar la extensión y la localización de las complicaciones. Según la gravedad, el tiempo de evolución y la extensión, hay distintos tipos de complicaciones y una variedad de hallazgos en TC.

Abstract Acute pancreatitis is an inflammatory pathology of the pancreas characterized by abdominal pain and elevated levels of serum amylase. In radiology, it is studied with computed tomography (CT), which is the preferred method to evaluate the extent and location of complications. Depending on the severity, time of evolution, and extent, there are different types of complications and a variety of findings on the CT scan.

Coinfección por Mycobacterium abscessus y Mycobacterium tuberculosis en un paciente con síndrome de Cushing exógeno y otras comorbilidades / Mycobacterium abscessus and Mycobacterium tuberculosis coinfection in a patient with exogenous Cushing syndrome and other comorbilities

RESUMEN Mycobacterium abscessus es una micobacteria no tuberculosa de crecimiento rápido, que produce infección pulmonar, cutánea, diseminada y otras, sobre todo en pacientes con comorbilidades. El diagnóstico se basa en la identificación de la micobacteria por medios de cultivo o por pruebas moleculares. El tratamiento con macrólidos y amikacina continúa siendo el ideal, aunque depende de la localización y de la gravedad de la infección, sin embargo, se han identificado genes de resistencia en algunas subespecies que limitan la eficacia antibiótica. Presentamos el caso de un paciente con coinfección cutánea por Mycobacterium abscessus y Mycobacterium tuberculosis, quien presenta un síndrome de Cushing exógeno, factor predisponente para estas infecciones. Además, se identificaron hidatidosis y aspergilosis pulmonares. El tratamiento antituberculoso del paciente se ajustó para manejar ambas micobacterias, y su evolución fue favorable.

ABSTRACT Mycobacterium abscessus is a fast-growing non-tuberculous mycobacterium that causes lung, skin, disseminated and other infections, mainly in patients with comorbidities. The diagnosis is based on the identification of the mycobacterium by culture media or molecular tests. Treatment with macrolides and amikacin remains the optimal choice, although it depends on the location and severity of the infection; however, resistance genes have been identified in some subspecies that limit antibiotic efficacy. We present the case of a patient with cutaneous coinfection by Mycobacterium abscessus and Mycobacterium tuberculosis, who presented exogenous Cushing syndrome, a predisposing factor for these infections. In addition, hydatidosis and pulmonary aspergillosis were identified. The patient's anti-tuberculosis treatment was adjusted to manage both mycobacteria, resulting in a favorable evolution.

Enhancement of ethanol production efficiency in repeated-batch fermentation from sweet sorghum stem juice: effect of initial sugar, nitrogen and aeration

BACKGROUND: Ethanol concentration (PE), ethanol productivity (QP) and sugar consumption (SC) are important values in industrial ethanol production. In this study, initial sugar and nitrogen (urea) concentrations in sweet sorghum stem juice (SSJ) were optimized for high PE (≥10%, v/v), QP, (≥2.5 g/L·h) and SC (≥90%) by Saccharomyces cerevisiae SSJKKU01. Then, repeated-batch fermentations under normal gravity (NG) and high gravity (HG) conditions were studied. RESULTS: The initial sugar at 208 g/L and urea at 2.75 g/L were the optimum values to meet the criteria. At the initial yeast cell concentration of ~1 × 108 cells/mL, the PE, QP and SC were 97.06 g/L, 3.24 g/L·h and 95.43%, respectively. Repeated-batch fermentations showed that the ethanol production efficiency of eight successive cycles with and without aeration were not significantly different when the initial sugar of cycles 2 to 8 was under NG conditions (~140 g/L). Positive effects of aeration were observed when the initial sugar from cycle 2 was under HG conditions (180­200 g/L). The PE and QP under no aeration were consecutively lower from cycle 1 to cycle 6. Additionally, aeration affected ergosterol formation in yeast cell membrane at high ethanol concentrations, whereas trehalose content under all conditions was not different. CONCLUSION: Initial sugar, sufficient nitrogen and appropriated aeration are necessary for promoting yeast growth and ethanol fermentation. The SSJ was successfully used as an ethanol production medium for a high level of ethanol production. Aeration was not essential for repeated-batch fermentation under NG conditions, but it was beneficial under HG conditions.

A Simple and Nonenzymatic Method to Isolate Human Corpus Cavernosum Endothelial Cells and Pericytes for the Study of Erectile Dysfunction

Validação de um instrumento para ensinar Centro de Gravidade para alunos com deficiência visual / Validation of an instrument to teach Gravity Center to visually impaired students

O Ensino de Ciências no ensino fundamental possibilita aos alunos o início de uma educação científica que, por conseguinte, desenvolverá uma capacidade mais crítica acerca do meio que os envolve, facilitando a tomada de decisões da vida cotidiana. O fato de se tratar do público de alunos com deficiência visual não tornará o ensino de Ciências diferente, mas as ações pedagógicas deverão se adequar às necessidades educacionais especiais desses alunos. Sabemos que no ensino não existe uma fórmula pronta, pois cada aluno é diferente. Sendo assim, tal pesquisa nada mais é do que uma proposta de um possível caminho e a apresentação de algumas das pistas possíveis para a continuação desse caminhar. O objetivo geral desta dissertação é ensinar o conceito de Equilíbrio ou Centro de Gravidade a partir da contação de uma história e de uma maquete tátil-visual para alunos com deficiência visual. A partir disso, fizemos uma validação: da história e da maquete tátil-visual. Como instrumento de pesquisa, utilizamos a observação, produzindo como registro a gravação em áudio do participante da pesquisa, que foi um professor de Ciências com cegueira congênita empregando a sequência de ensino por investigação. Tal pesquisa pode ser utilizada em outros contextos, com impacto na enculturação científica, tanto no campo da deficiência visual como no Ensino de Ciências.

Influences on the Functional Behavior of Great Arteries during Orthostasis / Gravidade Influencia o Comportamento Funcional das Grandes Artérias Durante a Ortostase

Abstract Background: Arterial compliance reduction has been associated with aging and hypertension in supine position. However, the dynamic effects of orthostatism on aortic distensibility has not been defined. Objective: We sought to determine the orthostatic influence and the interference of age, blood pressure (BP) and heart rate (HR) on the great arteries during gravitational stress. Methods: Ninety-three healthy volunteers (age 42 ± 16 years). Carotid-femoral pulse wave velocity (PWV) assumed as aortic stiffness was assessed in supine position (basal phase), during tilt test (TT) (orthostatic phase) and after return to supine position (recovery phase). Simultaneously with PWV acquisition, measures of BP and HR rate were recorded. Results: PWV during TT increased significantly compared to the basal and recovery phases (11.7 ± 2.5 m/s vs. 10.1 ± 2.3 m/s and 9.5 ± 2.0 m/s). Systolic BP (r = 0.55, r = 0.46 and r = 0.39) and age (r = 0.59, r = 0.63 and r = 0.39) correlated with PWV in all phases. The significance level for all tests was established as α = 0.05. Conclusion: We conclude that there is a permanent increase in PWV during orthostatic position that was returned to basal level at the recovery phase. This dynamic pattern of PWV response, during postural changes, can be explained by an increase in hydrostatic pressure at the level of abdominal aorta which with smaller radius and an increased elastic modulus, propagates the pulse in a faster way. Considering that it could increase central pulse reflection during the orthostatic position, we speculate that this mechanism may play a role in the overall adaptation of humans to gravitational stress.

Resumo Fundamento: A redução da complacência arterial tem sido associada ao envelhecimento e à hipertensão na postura supina. Entretanto, os efeitos dinâmicos do ortostatismo na distensibilidade aórtica não foram definidos. Objetivo: Determinar a influência ortostática e a interferência da idade, pressão arterial (PA) e frequência cardíaca (FC) sobre as grandes artérias durante o estresse gravitacional. Métodos: Noventa e três voluntários saudáveis (idade de 42 ± 16 anos). A velocidade da onda de pulso carotídeo-femoral (VOP), assumida como rigidez aórtica, foi avaliada na posição supina (fase basal) durante o teste de inclinação (TT) (fase ortostática) e após o retorno à posição supina (fase de recuperação). Simultaneamente à aquisição da PWV, registrou-se as medidas de PA e FC. Resultados: A VOP durante o TT aumentou significativamente em comparação com as fases basal e de recuperação (11,7 ± 2,5 m/s vs. 10,1 ± 2,3 m/se 9,5 ± 2,0 m/s). PA sistólica (r = 0,55, r = 0,46 e r = 0,39) e idade (r = 0,59, r = 0,63 e r = 0,39) correlacionaram-se com a VOP em todas as fases. O nível de significância para todos os testes foi estabelecido como = 0,05. Conclusão: Observou-se um aumento permanente da VOP durante a postura ortostática, que retornou ao nível basal na fase de recuperação. Esse padrão dinâmico de resposta da VOP, durante as alterações posturais, pode ser explicado pelo aumento da pressão hidrostática no nível da aorta abdominal que, com raio menor e aumento do módulo de elasticidade, propaga o pulso de maneira mais rápida. Considerando-se que poderia aumentar a reflexão do pulso central durante a posição ortostática, podemos especular que esse mecanismo pode desempenhar um papel na adaptação global do humano ao estresse gravitacional.

Percepción del riesgo mediante sus atributos psicosociales en trabajadores de la industria metalmecánica en la ciudad de Bogotá, D.C (Colombia) / Perception of the risk through its psychosocial attributes in workers of the metalmechanical industry in the city of Bogotá, D.C (Colombia)

Resumen Introducción. La percepción del riesgo en el ámbito laboral se convierte en un elemento crucial para entender las prácticas de trabajo inseguras de los trabajadores, teniendo en cuenta no solo las variables cognitivas sino también las psicosociales. Objetivo. Describir la percepción del riesgo mediante sus atributos psicosociales en trabajadores de la industria metalmecánica en la ciudad de Bogotá. Materiales y métodos. Estudio descriptivo transversal realizado en la ciudad de Bogotá, D.C, a través de una encuesta aplicada a los participantes del estudio. Resultados. La aplicación de la Guía NTP 578 a los trabajadores del sector metalmecánico permitió la realización del perfil comparativo de la magnitud del riesgo percibido y sus atributos para cada una de las actividades que se evaluaron. Conclusiones. Los trabajadores del sector metalmecánico, se sienten más vulnerables a las consecuencias que pueden generarles el uso de herramientas cortantes, la exposición al ruido y la exposición a gases y vapores, y le temen a la gravedad del daño que se puede derivar estos riesgos a los cuales están sometidos en su diario vivir en su entorno laboral.

Abstract Introduction. The perception of risk in the workplace becomes a crucial element to understand the unsafe work practices of workers, taking into account not only the cognitive variables but also the psychosocial ones. Objective. To describe the perception of risk through its psychosocial attributes in workers of the metal-mechanic industry in the city of Bogotá. Materials and methods: A cross-sectional descriptive study conducted in the city of Bogotá, D.C, through a survey applied to the study participants. Results. The application of the Guide NTP 578 to the workers of the metalworking sector allowed the realization of the comparative profile of the magnitude of the perceived risk and its attributes for each of the activities that were evaluated. Conclusions. Workers in the metalworking sector feel more vulnerable to the consequences that can result from the use of sharp tools, exposure to noise and exposure to gases and vapors, and fear the seriousness of the damage that can be derived from these risks to which they are subjected in their daily life in their work environment.

Effects of Virtual Reality Horse Riding Simulator Training Using a Head-Mounted Display on Balance and Gait Functions in Children with Cerebral Palsy: A Preliminary Pilot Study

PURPOSE: The purpose of this study was to investigate the effects of three-dimensional virtual reality horse riding simulator training using a head-mounted display on gait and balance in children with cerebral palsy.METHODS: Ten children with cerebral palsy were randomly assigned to the horse riding simulator (HRS) group (n=5) or the horse riding simulator with virtual reality (HRSVR) group (n=5). To evaluate balance, center of gravity (COG) sway velocity and total sway distance of each group were assessed using the Wii balance board, and gait speed and stride length of each group were assessed using a gait analysis system.RESULTS: Intra-group comparisons between pre- and post-intervention measures revealed that there were significant changes in all gait and balance variables such as stride length, gait velocity, COG sway velocity and COG sway distance in the HRSVR group (p<0.05). In the HRS group, there were significant changes in all variables except stride length (p<0.05). In addition, inter-group comparisons showed significant differences between the two groups in stride length, gait velocity and COG sway distance except COG sway velocity (p<0.05).CONCLUSION: The findings of this study suggest that horse riding simulator training combined with 3D virtual reality can be a new positive therapeutic approach for improving functional performance in children with cerebral palsy.

Points to consider before the insertion of maxillary implants: the otolaryngologist's perspective

Maxillary implants are inserted in the upward direction, meaning that they oppose gravity, and achieving stable support is difficult if the alveolar bone facing the maxillary sinus is thin. Correspondingly, several sinus-lifting procedures conducted with or without bone graft materials have been used to place implants in the posterior area of the maxilla. Even with these procedures available, it has been reported that in about 5% of cases, complications occurred after implantation, including acute and chronic sinusitis, penetration of the sinus by the implant, implant dislocation, oroantral fistula formation, infection, bone graft dislocation, foreign-body reaction, Schneiderian membrane perforation, and ostium plugging by a dislodged bone graft. This review summarizes common maxillary sinus pathologies related to implants and suggests an appropriate management plan for patients requiring dental implantation.

Finite element analysis of long-term changes of the breast after augmentation mammoplasty: Implications for implant design

The development of breast implant technology continues to evolve over time, but changes in breast shape after implantation have not been fully elucidated. Thus, we performed computerized finite element analysis in order to better understand the trajectory of changes and stress variation after breast implantation. The finite element analysis of changes in breast shape involved two components: a static analysis of the position where the implant is inserted, and a dynamic analysis of the downward pressure applied in the direction of gravity during physical activity. Through this finite element analysis, in terms of extrinsic changes, it was found that the dimensions of the breast implant and the position of the top-point did not directly correspond to the trajectory of changes in the breast after implantation. In addition, in terms of internal changes, static and dynamic analysis showed that implants with a lower top-point led to an increased amount of stress applied to the lower thorax. The maximum stress values were 1.6 to 2 times larger in the dynamic analysis than in the static analysis. This finding has important implications for plastic surgeons who are concerned with long-term changes or side effects, such as bottoming-out, after anatomic implant placement.

Standard Recipes for the Preparation of Thickened Barium Liquids Used in the Diagnosis of Dysphagia

Barium sulfate is commonly used to prepare contrast media for videofluorograpy. The flow characteristics of thickened liquids formulated for oropharyngeal imaging are known to be greatly affected by the addition of barium. In this study, thickened barium liquids were prepared by mixing a commercial xanthan gum (XG)-based thickener (Visco-up®) at different concentrations (0.1%–3.0%) with barium powder (Baritop HD®), and differences in the viscosity between thickened non-barium and thickened barium liquids were investigated. In addition, the thickness levels of thickened barium liquids, which are based on the National Dysphagia Diet (NDD) and International Dysphagia Diet Standardization Initiative (IDDSI) guidelines, were classified by measuring the viscosity (NDD) and gravity flow through a syringe (IDDSI) with 0.1%–3.0% thickener concentrations. The apparent viscosity (η(a),₅₀) values of thickened barium liquids were much higher than those of thickened non-barium liquids, indicating that the addition of barium to the XG-based thickener resulted in further thickening. Standard recipes for preparing thickened barium liquids with desirable thickness levels were also established, showing the different thickener concentrations corresponding to the different NDD and IDDSI levels.

Identification of Vestibular Organ Originated Information on Spatial Memory in Mice / 대한평형의학회지

OBJECTIVES: We aimed to study the role of vestibular input on spatial memory performance in mice that had undergone bilateral surgical labyrinthectomy, semicircular canal (SCC) occlusion and 4G hypergravity exposure. METHODS: Twelve to 16 weeks old ICR mice (n=30) were used for the experiment. The experimental group divided into 3 groups. One group had undergone bilateral chemical labyrinthectomy, and the other group had performed SCC occlusion surgery, and the last group was exposed to 4G hypergravity for 2 weeks. The movement of mice was recorded using camera in Y maze which had 3 radial arms (35 cm long, 7 cm high, 10 cm wide). We counted the number of visiting arms and analyzed the information of arm selection using program we developed before and after procedure. RESULTS: The bilateral labyrinthectomy group which semicircular canal and otolithic function was impaired showed low behavioral performance and spacial memory. The semicircular canal occlusion with CO₂ laser group which only semicircular canal function was impaired showed no difference in performance activity and spatial memory. However the hypergravity exposure group in which only otolithic function impaired showed spatial memory function was affected but the behavioral performance was spared. The impairment of spatial memory recovered after a few days after exposure in hypergravity group. CONCLUSIONS: This spatial memory function was affected by bilateral vestibular loss. Space-related information processing seems to be determined by otolithic organ information rather than semicircular canals. Due to otolithic function impairment, spatial learning was impaired after exposure to gravity changes in animals and this impaired performance was compensated after normal gravity exposure.

Prediction of air inflow during central venous catheter insertion: experimental study

OBJECTIVE: This study examined the incidence and amount of air inflow during central venous catheter (CVC) insertion. METHODS: This study was an experimental study aimed at designing an apparatus to implement blood vessel and blood flow in the human body. A 1.5-m long core tube with a Teflon tube, suction rubber tube, and polyvinyl chloride tube were made. This core tube was assumed to be the blood vessel of the human body. Blood was replaced with a saline solution. The saline solution was placed higher than the core tube and flowed into the inside of the tube by gravity. The CVC was injected 15-cm deep into the core tube. The air was collected through a 3-way valve into the upper tube. The experiments were carried out by differentiating the pressure in the tube, CVC insertion step, and diameter of the end of the catheter. The experiment was repeated 10 times under the same conditions. RESULTS: The amount of air decreased with increasing pressure applied to the tube. Air was not generated when the syringe needle was injected, and the amount of air increased with increasing size of the distal end catheter. CONCLUSION: To minimize the possibility of air embolism, it is necessary to close the distal end catheter at the earliest point as soon as possible.

Immediate Effect of Postural Control of the Contra-Lateral Side on Exercise-Induced Fatigue of the Ipsi-Lateral Plantar Flexor Muscle

PURPOSE: The purpose of the current study was to examine the effects of exercise-induced fatigue of the plantar flexor muscle in the dominant ankle on the plantar flexor strength and postural control function of the contra-lateral side. METHODS: Twenty-one young adults (male: 10, female: 11) volunteered to participate in this study. An exercise-induced fatigue protocol to induce fatigue was performed in the plantar flexor of the dominant ankle. For the fatigue protocol, the participants were instructed to raise their heels as high as possible in the position with one leg stance of the dominant lower limb, and the heel was then downed after holding for 1 second. The muscle strength of the contra-lateral plantar flexor was measured using a digital muscle strength test device, and the static and dynamic postural control were tested by acquiring the center of gravity velocity while performing one leg standing. A paired t-test was used to identify the differences between the pre- and post, and the data were analyzed using SPSS 12.0 software. RESULTS: Comparison of the pre- and post-test data revealed a significant difference in the plantar flexor strength and dynamic postural control after exercise-induced muscle fatigue in the dominant side. On the other hand, there was no significant difference in the static postural control. CONCLUSION: These findings have practical implications, suggesting that unilateral muscle fatigue affects the ankle muscle strength and postural ability of the contralateral side.

Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists / 결핵및호흡기질환

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity (“water seal”) drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.

Pulmonary aspiration during intubation in a high-risk patient: A video clip and clinical implications

We report a case of pulmonary aspiration during induction of general anesthesia in a patient who was status post esophagectomy. Sudden, unexpected aspiration occurred even though the patient had fasted adequately (over 13 hours) and received rapid sequence anesthesia induction. Since during esophagectomy, the lower esophageal sphincter is excised, stomach vagal innervation is lost, and the stomach is flaccid, draining only by gravity, the patient becomes vulnerable to aspiration. As the incidence of perioperative pulmonary aspiration is relatively low, precautions to prevent aspiration tend to be overlooked. We present a video clip showing pulmonary aspiration and discuss the literature concerning the risk of aspiration and its preventive strategies.

Improvement of ethanol production from sweet sorghum juice under batch and fed-batch fermentations: effects of sugar levels, nitrogen supplementation, and feeding regimes

Background: Fermentation process development has been very important for efficient ethanol production. Improvement of ethanol production efficiency from sweet sorghum juice (SSJ) under normal gravity (NG, 160 g/L of sugar), high gravity (HG, 200 and 240 g/L of sugar) and very high gravity (VHG, 280 and 320 g/L of sugar) conditions by nutrient supplementation and alternative feeding regimes (batch and fed-batch systems) was investigated using a highly ethanol-tolerant strain, Saccharomyces cerevisiae NP01. Results: In the batch fermentations without yeast extract, HG fermentation at 200 g/L of sugar showed the highest ethanol concentration (PE, 90.0 g/L) and ethanol productivity (QE, 1.25 g/L·h). With yeast extract supplementation (9 g/L), the ethanol production efficiency increased at all sugar concentrations. The highest PE (112.5 g/L) and QE (1.56 g/L·h) were observed with the VHG fermentation at 280 g/L of sugar. In the fed-batch fermentations, two feeding regimes, i.e., stepwise and continuous feedings, were studied at sugar concentrations of 280 g/L. Continuous feeding gave better results with the highest PE and QE of 112.9 g/L and 2.35 g/L·h, respectively, at a feeding time of 9 h and feeding rate of 40 g sugar/h. Conclusions: In the batch fermentation, nitrogen supplementation resulted in 4 to 32 g/L increases in ethanol production, depending on the initial sugar level in the SSJ. Under the VHG condition, with sufficient nitrogen, the fed-batch fermentation with continuous feeding resulted in a similar PE and increased QP by 51% compared to those in the batch fermentation.

Novel Measurement Technique for the Sagittal Vertical Axis and Its Clinical Application in Adult Spinal Deformity

STUDY DESIGN: Prospective physical measurement of the sagittal vertical axis (SVA). PURPOSE: To evaluate a simple method for measuring SVA by analyzing its relationship with radiographic measurements and clinical appearance. OVERVIEW OF LITERATURE: No studies have examined physical measurements using the cranial center of gravity (CCG) in a relaxed standing position. METHODS: The physical measurement of the horizontal distance between CCG and spina iliaca posterior superior (CCG-SIPS) was measured using a straight ruler in 252 healthy volunteers and 56 patients with adult spinal deformity. Health-related quality of life (HRQOL) was evaluated using the Oswestry disability index (ODI), and clinical symptoms were assessed according to standing status and the presence of gastroesophageal reflux disease (GERD). RESULTS: CCG-SIPS increased with age in the volunteer group and strongly correlated with radiographic SVA in the patient group (r=0.984). Differences increased between CCG-SIPS in patients in the relaxed position and radiographic SVA with an increase in sagittal malalignment (r=0.692, p120 mm) was significantly larger in the patient group than in the group with low sagittal malalignment (59.9±18.8 vs. 45.1±17.0; p=0.004); these patients (CCG-SIPS>120 mm) needed crutches or walkers for standing. The patient group with GERD had significantly larger sagittal malalignment than the group without GERD (160.3 mm vs. 81.0 mm). CONCLUSIONS: The CCG-SIPS correlated with age and strongly reflected radiographic SVA and HRQOL in the patients. Moreover, it reflects a relaxed posture without a backward shift in the radiographic position even in patients with severe sagittal malalignment. The critical limit of CCG-SIPS can be relevant to clinical appearance, including standing assistance (>120 mm) and the existence of GERD (>150 mm). Thus, it will be a useful predictor of true SVA in clinical practice before radiographic evaluation.

Mixed Tumor in Deep Lobe and Versatility of Acellular Dermal Matrix

Frey's syndrome and infra-auricular depressed deformities are the ones of the most common complications that can occur after total parotidectomy. We report 1 case of pleomorphic adenoma occurred in the deep lobe that obtained good results from using acellular dermal matrix (ADM) after total parotidectomy. A 24-year-old man visited the hospital with oval shape mass in right mandibular angle which of 4 cm in size was found in the deep lobe of right parotid gland from Magnetic resonance imaging scanning and a pleomorphic adenoma was suspected. A total parotidectomy was performed while preserving the facial nerve. The material known as ADM were placed in the depressed part from where the mass was removed, and the site was sutured. The surgery site was healed well without any complications such as Frey's syndrome or infra-auricular depressed deformities. The pathological result was confirmed as pleomorphic adenoma. In addition to these advantages, it does not have little potential of deformation by the gravity after the surgery, and there is no restraint on circulation, which makes fabrication free and each deformation into various shapes can be described as another advantage of the reconstruction using the ADM.