Total Facelift: Forehead Lift, Midface Lift, and Neck Lift

Patients with thick skin mainly exhibit the aging processes of sagging, whereas patients with thin skin develop wrinkles or volume loss. Asian skin is usually thicker than that of Westerners; and thus, the sagging of skin due to aging, rather than wrinkling, is the chief problem to be addressed in Asians. Asian skin is also relatively large in area and thick, implying that the weight of tissue to be lifted is considerably heavier. These factors account for the difficulties in performing a facelift in Asians. Facelifts can be divided into forehead lift, midface lift, and lower face lift. These can be performed individually or with 2-3 procedures combined.

Augmentation of the Chin with a Silicone Implant

A line is drawn from the nasal tip to the most anterior point of the lower lip. The distance from soft tissue pogonion to the ideal soft tissue pogonion is the amount of correction. Alloplastic augmentation does not correct the soft tissue in a 1:1 ratio. In the case of a patient having normal soft tissue(8~11 mm), the ratio of the soft tissue correction is 1:0.66. In the case of a patient having a soft tissue deficiency(less than 7mm), the ratio of the soft tissue correction is 1:0.8. In the case of a patient having a soft tissue excess(more than 12mm), the ratio of the soft tissue correction is 1:0.5. The length of the implant is required to be more lateral to the mental foramen by 1~1.5 cm for restoration of the prejowl sulcus. The posterior surface of the implant must be carved to shape precisely to the bony surface. I usually make several vertical etchings and 20~30 holes in the implant. The vertical etchings help expand the implant to securely fit the mandibular contour. Fenestrated silastic implants can be further stabilized with fibrous tissue ingrowth and future reconstruction if bony erosion occurs.

Cross-linking of CD80 and CD86 Diminishes Expression of CD54 on EBV-transformed B Cells through Inactivation of RhoA and Ras

BACKGROUND: Epstein Barr virus (EBV) infected B cells are transformed into lymphoblastoid cell lines. Some researchers suggested some a few similarities between this process and carcinogenesis. We observed the expression of CD80 and CD86, co-stimulatory molecules on EBV-transformed B cells and changes of CD54 expression after stimulation of CD80 and CD86. METHODS: CD80 and CD86 were stimulated using anti-CD80 and anti-CD86 monoclonal antibodies. To assess apoptosis and surface protein expression, flow cytometric analysis was performed. Intracellular signal molecules were evaluated by RT-PCR and immunoblot. Morphology and localization of proteins were examined using inverted or confocal microscope. RESULTS: Cross-linking of CD80 and CD86 induced apoptosis and interfered with proliferation of EBV-transformed B cells, and dispersion of clumped cells. We also examined that their stimulation induced ROS accumulation and reduced CD54 expression. Interestingly, we observed that CD80 and CD86 diminished the expression of CD54 in different methods. Both CD80 and CD86 down-regulated activation of focal adhesion kinase. CD80 stimulus inhibited CD54 expression through mainly RhoA inactivation, while CD86 down-regulated Ras and JNK phosphorylation. CONCLUSION: These results suggest that co-stimulatory CD80 and CD86 molecules, expressed EBV-transformed B cells, may play a role in apoptosis and cell adhesion.

Extended SMAS Facelift

In order to solve the problems related to aging faces, new techniques, including various kinds of barbed suture technique, are developing in present time. Although these several kinds of noninvasive or minimal invasive method for aging face have their own indication and barely complications, these procedures would be less effective than the extended SMAS technique used on those of Oriental person. In the face, there are some retaining ligaments, which support facial soft tissue against gravitational change. With aging, the cheek soft tissue anterior to the zygomatic ligament and posterior to the mandibular ligament descends into the plane between the superficial and deep fascia. However, the attached area by the zygomatic and mandibular retaining ligaments are almost unchanged because the ligaments that support facial soft tissue in normal anatomic position i.e, ligaments retain their integrity while the soft tissue around it relaxes. These changes lead to the formation of a nasolabial fold and jowl. I think the most important consideration factor before choosing a certain procedure is to decide which procedure could bring more predictable results, make longer lasting effect, and has minimal risk and morbidity. In my opinion, it is rationally impossible to say that one technique is better than the other. I always try to keep in mind that no two patients are the same, so whenever I do my technique, I try to adjust and adapt my technique according to individual specifications. Among the multiple problems related to aging, there are three distinctive features, which are wrinkles, volume loss, and drooping facial soft tissue. There is no single method for removing these problems. If the wrinkles are the main problem, we can get the best result by facial resurfacing. If somebody has deep wrinkles, fold, and drooping facial soft tissue, I usually perform the extended SMAS facelift. I always do it with local anesthesia. Under the intravenous sedation with ketamine, midazolam, and propofol, I infiltrate 2% lidocaine with 1:80,000 epinephrine along the proposed incision line. Next, the tumescent solution is infiltrated into the face and neck dissection area. A total of 300-400ml of tumescent solution is infiltrated on the both sides of the face and neck. After infiltration, I begin working on the neck area first and then try to solve the facial problems. Different problems require different amount of subcutaneous and SMAS dissection. If the patient's main problem is wrinkle and one has a thin skin, one requires wide skin dissection and extended SMAS technique. If the patient's main problem is wrinkle and one has a thick skin, one requires narrow skin dissection and extended SMAS technique. If the patient's main problem is drooping and one has a thin skin, one requires narrow skin dissection and extended SMAS technique. If the patient's main problem is drooping and one has a thick skin, one requires wide skin dissection and extended SMAS technique. If somebody receives foreign body injection or secondary facelift, I do my procedure in case by case.

Extended SMAS Facelift

In order to solve the problems related to aging faces, new techniques, including various kinds of barbed suture technique, are developing in present time. Although these several kinds of noninvasive or minimal invasive method for aging face have their own indication and barely complications, these procedures would be less effective than the extended SMAS technique used on those of Oriental person. In the face, there are some retaining ligaments, which support facial soft tissue against gravitational change. With aging, the cheek soft tissue anterior to the zygomatic ligament and posterior to the mandibular ligament descends into the plane between the superficial and deep fascia. However, the attached area by the zygomatic and mandibular retaining ligaments are almost unchanged because the ligaments that support facial soft tissue in normal anatomic position i.e, ligaments retain their integrity while the soft tissue around it relaxes. These changes lead to the formation of a nasolabial fold and jowl. I think the most important consideration factor before choosing a certain procedure is to decide which procedure could bring more predictable results, make longer lasting effect, and has minimal risk and morbidity. In my opinion, it is rationally impossible to say that one technique is better than the other. I always try to keep in mind that no two patients are the same, so whenever I do my technique, I try to adjust and adapt my technique according to individual specifications. Among the multiple problems related to aging, there are three distinctive features, which are wrinkles, volume loss, and drooping facial soft tissue. There is no single method for removing these problems. If the wrinkles are the main problem, we can get the best result by facial resurfacing. If somebody has deep wrinkles, fold, and drooping facial soft tissue, I usually perform the extended SMAS facelift. I always do it with local anesthesia. Under the intravenous sedation with ketamine, midazolam, and propofol, I infiltrate 2% lidocaine with 1:80,000 epinephrine along the proposed incision line. Next, the tumescent solution is infiltrated into the face and neck dissection area. A total of 300-400ml of tumescent solution is infiltrated on the both sides of the face and neck. After infiltration, I begin working on the neck area first and then try to solve the facial problems. Different problems require different amount of subcutaneous and SMAS dissection. If the patient has thick facial skin and his or her main problem is drooping, wide skin area and SMAS undermining beyond the retaining ligaments is required. If the patient has thick facial skin and the main problem is wrinkles, less skin area and wide SMAS dissection is needed.

The Effect of the Transcriptional Regulation of Sp1 for TGF-beta1 and CTGF Expression in Scar Formation

This study is to examine the relationship between TGF-b1 expression and CTGF expression, and to evaluate the effect of Sp1 blockade on the expression of TGF-b1, CTGF and extracellular genes, clones of fibroblasts stably transfected with Sp1 decoy ODN. R-Sp1 decoy ODN was highly resistant to degradation by nucleases or serum, compared to the linear or phosphorothioated-Sp1 decoy ODN. Skin wounds were created on the back of 36 anesthetized rats. They were divided into four groups-the rats with normal skin, with wounded skin without decoy, with wounded skin injected with R-Sp1 decoy, and with wounded skin injected with mismatched R-Sp1 decoy, respectively. Skins were collected at 3rd, 5th, 7th, 14th day after wounding. Cellular RNA was extracted by RT-PCR analysis. TGF-beta1 and CTGF were deeply related with skin fibrosis during scar formation and it appeared that TGF-beta1 may cause the induction of CTGF expression. R-Sp1 decoy ODN inhibited TGF-beta1 and CTGF expression both in cultured fibroblasts and in the skin of rats. These results indicate that targeting Sp1 with R-type decoy efficiently blocks extracellular matrix gene expression, and suggest an important new therapeutic approach to control the scarring in normal wound healing and fibrotic disorders.

Differentiation of Tuberculous Pneumonia and Community-acquired Pneumonia: Usefulness of Chest Radiography and Serum CA-125

PURPOSE: To determine whether tuberculous pneumonia can be distinguished from community-acquired pneumonia on the basis of chest radiographic findings only and the diagnostic utility of differences in serum CA-125 levels. MATERIALS AND METHODS: Forty-five patients with a high fever (>38 'C) in whom chest radiography revealed lobar consolidation were retrospectively studied. In 27 cases, the presence of acid-fast bacilli in sputum (n=21), the isolation of Mycobacterium tuberculosis from bronchoscopic biopsy tissue and sputum cultures (n=16), and improvement in the findings of serial radiography and in clinical symptoms during antituberculous therapy (n=1) let to a diagnosis of tuberculous pneumonia. A diagnosis of community-acquired pneumonia (n=18) was based on improvement in the serial radiographic findings obtained during antibacterial therapy (n=16), and the isolation of bacteria from sputum and pleural fluid culture (n=2). On the basis of independently analysed findings, radiologist determined the presence or absence of nodular density, cavitary lesions and loss of lung volume, while two radiologists differentiated between tuberculous pneumonia and community-acquired pneumonia. RESULT: Initial chest radiographs of tuberculous pneumonia revealed nodular density in 89% of cases, cavitary lesions in 29%, and loss of lung volume nodular density was in 26%, while those of community-acquired pneumonia demonstrated nodular density in only 22%, cavitary lesions in 6%, and loss of lung volume in none was a significant statistical difference in nodular density, cavitary lesions and loss of lung voume (p<0.005). The average serum CA-125 level in tuberculous pneumonia was 306.5 (range, 21.3 -1078) U/ml, whereas the average level in community-acquired pneumonia was 38.0 (range, 11.3 -114.8) U/ml (p<0.005). CONCLUSION: Initial chest radiography can differentiate between tuberculous and community-acquired pneumonia on the basis of nodular density, cavitary lesions and loss of lung volume and differences in CA-125 levels also provide a useful means of differentiating between these pneumonias.

Microwave Tissue Coagulation: Effects of Power and Treatment Time on Coagulation size

PURPOSE: To determine the effects of power and coagulation time on lesion size of ex-vivo bovine liver using microwaves. MATERIALS AND METHODS: Six bovine livers were divided into two groups(first group: 30W output, secondgroup: 60W output) and microwave coagulation was performed for 30, 60, and 120 sec. thermal injury site was thenobserved by means of sonography, and the maximal transverse diameter of the echo-change portion after microwave coagulation was measured. On the section of specimen, maximal transverse diameters of the thermal injury site weremeasured by gross inspection and compared with the result of sonographic measurement. RESULTS: Maximal transversediameters of hyperechoic lesions of the first group, as seen on sonography were 8.3 mm, 12.2mm, and 15.6mm, andthe maximal transverse diameters of thermal injury sites on gross specimens were 9.1mm, 12.0mm, and 15.1mm,respectively. Maximal transverse diameters of hyperechoic lesions of the second group, as seen on sonography, were12.1 mm, 17.4 mm, and 21.2 mm and maximal transverse diameters of thermal injury sites on gross specimens were13.2 mm, 16.0 mm, and 20.0 mm, respectively. Statistically maximal transverse diameters of hyperechoic lesions, asseen on sonography, correlated closely with the gross findings of maximal transverse diameters of thermal injurysites(p<0.05). CONCLUSION: Maximal transverse diameters of thermal injury sites were significantly increased asthe output of the microwave coagulator and the duration of coagulation time increased(p<0.05).

Effects of Intrahepatic Blood Vessels on Size and Shape of Microwave Coagulation

PURPOSE: To determine the effects of blood vessels on the size and shape of microwave coagulation. MATERIALS AND METHODS: Microwave coagulation was performed with 60 W output and 60 second duration. In the first experiment five exvivo porcine livers were used to determine the size of the coagulation area and its reproducibility. The second experiment involved the used of two in-vivo porcine livers to determine how adjacent vessels affect the size and shape of coagulation. RESULTS: The result of the first experiment was that the maximum mean diameter of lesions was 1.4 cm +/- 0.1 , reproducible in the range of 1.3 c m -1 .5 cm. In the second experiment, maximum mean diameter was found to be 1.5cm +/- 0.1, reproducible in the range of 1.3 cm - 1.7cm, and the size and shape of the lesion was affected by nearby blood vessels. The shape factor of the lesion, defined as roundness of sphere, was 0.8, but the r a n g e ( 0 . 5 8 -0.92) was wide due to the effect of vascular cooling. This was more prominent in the portal vein than in the hepatic vein, and the minimum diameter of the portal vein which deformed the lesion by more than 1 mm was 0.1 mm. CONCLUSION: Microwave coagulation gives a well-defined lesion, the size of which can be reproduced, but size variation and nonuniformity can be caused by nearby blood vessels.

Effects of Intrahepatic Blood Vessels on Size and Shape of Microwave Coagulation

PURPOSE: To determine the effects of blood vessels on the size and shape of microwave coagulation. MATERIALS AND METHODS: Microwave coagulation was performed with 60 W output and 60 second duration. In the first experiment five exvivo porcine livers were used to determine the size of the coagulation area and its reproducibility. The second experiment involved the used of two in-vivo porcine livers to determine how adjacent vessels affect the size and shape of coagulation. RESULTS: The result of the first experiment was that the maximum mean diameter of lesions was 1.4 cm +/- 0.1 , reproducible in the range of 1.3 c m -1 .5 cm. In the second experiment, maximum mean diameter was found to be 1.5cm +/- 0.1, reproducible in the range of 1.3 cm - 1.7cm, and the size and shape of the lesion was affected by nearby blood vessels. The shape factor of the lesion, defined as roundness of sphere, was 0.8, but the r a n g e ( 0 . 5 8 -0.92) was wide due to the effect of vascular cooling. This was more prominent in the portal vein than in the hepatic vein, and the minimum diameter of the portal vein which deformed the lesion by more than 1 mm was 0.1 mm. CONCLUSION: Microwave coagulation gives a well-defined lesion, the size of which can be reproduced, but size variation and nonuniformity can be caused by nearby blood vessels.

Subcapital Stress Fracture of the Femur after Internal Fixation of Intertrochanteric Fracture: A case report / 대한정형외과학회잡지

Fracture of the femoral neck occurred after internal fixation of intertrochanteric fracture of the femur is very rare and have been described previously in terms of stress fracture, stress-riser fracture, Youngs modulus fracture or iatrogenic fracture in the literature. This fracture documented about 20 cases in the English literature and usually occurred in elderly patients with osteoporosis and it always occur in the subcapital region. We report a case of subcapital stress fracture of the femur occurred after internal fixation with compression hip screw of intertrochanteric femur fracture.

Publication Patterns of Paper Presented at the Annual Fall Congress of the Korean Orthopaedic Association / 대한정형외과학회잡지

Presentation of research work is an important first step toward effective scientific communication of the research results. To determine the current puhlication patterns of the paper presented at the annual fall congress of the Korean Orthopaedic Association, we analysed 357 orally presented ahstracts at the 38th annual fall congress of the Korean Orthopaedic Asssociation which was held in 1994. This search revealed that full-length articles of 156 ahstracts (44%) were puhlished in the Journal of the Korean Orthopaedic Asssociation (121 ahstracts, 34%) and the Journals asssociated with the Korean Orthopaedic Asssociation (35 ahstracts, I 0%). The number of published papers was greatest in fracture part, followed by spine part, hip part, etc. It took ahout 13 months mean interval to publish at journal since oral presented date. The puhlication rate 44% was relatively low compared with the reports of various foreign disciplines. So endeavors to increase publication rates of orally presented papers will he needed.

US-guided Left-sided Percutaneous Biliary Drainage: Analysis of the Technical Factors Related to Procedure

PURPOSE: To evaluate the factors affecting procedure related technical difficulties of US-guided left sidedPTBD and the complications involved in the use of this method. MATERIAL AND METHODS: We prospectively evaluatedUS-guided left PTBD in 26 patients with malignant biliary obstructions. The causes of underlying malignancy werebile duct carcinoma(n=10), adenocarcinoma of the pancreas(n=8), GB carcinoma(n=4), metastasis to the portahepatis(n=2), duodenal carcinoma(n=1), hepatocellular carcinoma(n=1). We divided the procedure into four steps forthe evaluation of technical difficulties, and we measured procedure time and fluoroscopic exposure time. And weevaluated the incidence of procedure related complications. RESULTS: US-guided left PTBD was successful in allattempted cases. The average procedure time and fluoroscopic exposure time involved were 14.2 min. and 5.5 min.,respectively. From the first step to the fourth step, the average time required was 4.4 min, 2.3 min., 1.9 min.,5.6 min., respectively. One major complication involved sepsis(3.8%), and ten minor complications including fivetransient hemobilia(19.2%), three tube malfunction(11.5%), and two fever(7.6%). CONCLUSION: US-guided left PTBDwas easy to perform and a relatively safe method. The total procedure time was short, and as the radiologistbecomes more experienced, this could be further reduced.

Limited Two Incision Technique in Carpal Tunnel Release / 대한정형외과학회잡지

Open carpal tunnel release surgery has heen the gold standard method of treatment for who did not respond to conservative treatment and whose neurologic symptoms were progressive. However, open carpal tunnel release using a standard incision frequently associated with delayed return of hand function, residual scar tenderness and pillar pain. So, two new alternative methods such as endoscopic carpal tunnel release and limited incision technique have developed. To define the role of the limited two incision technique, we anaiyzed the postoperative functional results of 40 cases in 33 patients. The patients were divided in two groups. Group A was standard incision group (23 cases in 19 patients) and Group B was limited two incision group (l7 cases in 14 patients). The postoperative functional results were analyzed statistically using chi-square test at postoperative 3, 6, 9 and l2 weeks. There were no significant differences in reliet of numbness and paresthesias in both groups. There was a statistically significant difference in relief of scar tenderness and pillar pain at postoperative 3 and 6 weeks in Group B. There was no significant complication in both groups. We can conclude that the limited two incision technique of carpal tunnel release is a safe procedure which allows rapid return of hand functions with reduced incidence of scar tenderness in the early postoperative stages.

The Operative Treatment for the Fractures of Distal Femur / 대한정형외과학회잡지

The management of distal femur fractures are difficult because of many complications including nonunion, delayed union, infection, loss of fixation, joint stiffness and angular deformity. Until 1960s, conservative management was considered superior to operative treatment in distal femur fracture. But, with advancement of new fixation devices and techniques, open reduction and internal fixation is recent trend. For the purpose of analyzing the factors effecting the results, we studied the 36 cases of distal femur fracture treated surgically from may, 1991 to May, 1994. By AO classification nineteen cases were type C fracture and seventeen cases were type A. According to Schatzker and Lambert criteria, excellent results were in 10 cases, good in 16, fair in 6 and fail in 4. We have analysed the results by fixation device, age, osteoporosis degree, fracture classification, open or closed fracture, operative approach in type C fracture and bone graft. Fair and fail results were more common in the cases of severe osteoporotic bone, type C with lateral approach and open fracture. Excellent and good results were more common in the cases of using the anatomical plate and dynamic condylar screw. We concluded that treatment device should be decided by fracture type, degree of communication, degree of osteoporosis and soft tissue state, and then satisfactory results will be obtained by accurate anatomical reduction, rigid internal fixation and early exercise.