Treatment of Severe Blepharoptosis after Blow Out Fracture

PURPOSE: Blepharoptosis can result from either congenital or acquired causes. Blow out fracture or facial bone fracture including blow out fracture can be one of the causes. Authors experienced 3 cases of severe blepharoptosis after blow out fracture treated only with observation after reduction of associated fracture. METHODS: Reconstruction of orbital wall was conducted on all cases diagnosed as blow out fracture using 3 dimensional computed tomography, and conservative treatment was done on accompanying severe blepharoptosis. RESULTS: At the time of injury, all cases showed severe blepharoptosis requiring frontalis muscle transfer for correction. But blepharoptosis was recovered in an average of 18 weeks without any surgical procedure except reconstruction of orbital wall. CONCLUSION: Once Blepharoptosis occurred after blow out fracture, thorough evaluation must be done at first. If definitive cause of blepahroptisis cannot be found as authors' cases, injury of oculomotor nerve may result in blepharoptosis. So, as for blepharoptosis after blow out fracture, conservative treatment following reconstruction of fractured orbital wall can be one of good management.

Risk factor of influenza virus infection to febrile convulsions and recurrent febrile convulsions in children / 소아과

PURPOSE: Febrile convulsions are a common pediatric neurological disease, and it is important to prevent such a disease by controlling the risk factors that may recur. A recent report states that influenza virus infections have a high probability of a relationship with febrile convulsions; therefore, it is necessary to identify the clinical properties of febrile convulsions in relation to domestic influenza virus infections. METHODS: Between November 2005 and February 2008, children hospitalized because of febrile convulsions and subsequently confirmed to have influenza infections were enrolled as subjects (patient group, n=11). The control subjects were those admitted with influenza virus infections but no febrile convulsions (control group 1, n=46) and those who developed febrile convulsions without influenza virus infection (control group 2, n=53). RESULTS: The patient group showed a higher maximum body temperature (39.3+/-0.5degrees C), more histories of past febrile convulsions (72.7%), and a shorter total duration of fever (2.9+/-1.2 days) than control group 1. When multivariate analysis was performed, the probability of febrile convulsions was found to be as high as 225.9 times in patients who had influenza virus infections with a past history of febrile convulsions (OR=225.9, 95% CI: 1.7-4780.0, P<0.05). When patients with febrile convulsions were compared based on the symptoms of influenza virus infections, the patient group showed a shorter duration of fever (0.9+/-0.7 days) before convulsion than control group 2; these convulsions were mostly a recurrence of febrile convulsions. When multivariate analysis was performed, the cases with a past history of febrile convulsions showed 5.5 times (OR=5.5, 95% CI: 1.2-25.1, P=0.03) the probability of convulsions when infected with the influenza virus, and this probabilit. decreased by 0.3 times over one-day increments of the febrile period until febrile convulsions (95% CI: 0.1-0.9, P=0.02). Maximum body temperature, total duration of fever, family history of febrile convulsions, and complex febrile convulsions did not show a statistical significance. CONCLUSION: In cases of pediatric influenza virus infection, the past history of febrile convulsions could be identified within the risk factor of recurrent febrile convulsions. Therefore, influenza vaccination of children having a past history of febrile convulsions will be helpful to avoid the recurrence of these convulsions.

Effectiveness of the Ultrasonography in the Evaluation Following Orbit Wall Reconstruction

PURPOSE: Blow out fracture resulting from facial trauma is of high frequency among facial bone fractures, and can cause severe complications. So, proper post-operative management and close observation are needed. So far, Computed tomography has been the best method in evaluating following orbit wall reconstruction. However, cost-effectiveness, accessibility to patients and hazard of radiation exposure of computed tomography require supplementary measure for the evaluation following orbit wall reconstruction. This study was performed to describe the effectiveness of ultrasonography in the evaluation following orbit wall reconstruction. METHODS: A retrospective study was performed on 40 patients who underwent orbit wall reconstruction from June, 2008 to July, 2008. The patients' ages ranged from 13 to 65 years with the mean of 27.5 years. The patient group was composed of 27 males and 13 females. The follow up period ranged from 2 weeks to 28 weeks with the mean of 11 weeks. Preoperatively, all fractures were diagnosed using computed tomography. Ultrasonography for all cases, and computed tomography for 2 cases were performed for evaluation following orbit wall reconstruction. RESULTS: Reduction of herniated orbital soft tissue and orbit implant was identified by using ultrasonography in 38 cases out of 40 cases. In other cases which we could not identify the orbit implant, computed tomography was performed. CONCLUSION: Compared to computed tomography, ultrasonography is a simple, inexpensive and convenient method. Ultrasonography can be used as supplementary measure to computed tomography in the evaluation following orbit wall reconstruction for elective patients.

A Case Report of Congenital Eyelid Defect without Any Other Deformities

PURPOSE: Congenital upper eyelid defect is rare anomaly whether it is compared with syndromic anomaly or not. It has many clinical manifestation in the extent, location. Many operation procedures such as simple closure, semicircular rotation flap, Cutler Beard procedure, lower lid rotation flap, etc can be used to reconstruct eyelid defects. We intend to introduce a simple, congenital eyelid defect which was not compared with syndromical anomaly, ophthalmic complication. METHODS: Our experience is a case of 19 years old female who had a upper eyelid coloboma without any other anomalies. we could not find any skeletal deformity in orbital CT scan. she had no ophthalmic problem. we reconstructed the defect with bilateral marginal flap after deepithelization of supramarginal area and tarsal reposition. RESULTS: There were no visible deformity of lid lining. postoperative scar was favorable. satisfactory results were obtained in cosmetic and functional aspects. CONCLUSION: Upper lid coloboma without other anomalies is rare. we obtained satisfactory outcome as treated this rare case with marginal flap advancement.

Comparison of the seroconversion rate after primary hepatitis B vaccination and after revaccination of non-responders in full-term infants according to mother's HBsAg seropositivity / 소아과

PURPOSE: This study aimed to identify the true extent of non-responsiveness in full-term infants born from HBsAg-negative or HBsAg-positive mothers and vaccinated against hepatitis B virus (HBV) at 0, 1, and 6 months of age and to evaluate the effect of revaccination among non-responders. METHODS: The study included 716 full-term infants born in 2004-2007. Of 716, 662 infants (A group) were born to HBsAg- negative mothers and 54 infants (B group: 50, except HBsAg-positive infants) were born to HBsAg-positive mothers. All infants were administered DNA recombinant vaccines at 0, 1, and 6 months of age. B group infants received hepatitis B immunoglobulin at birth. Anti-HBs titers were tested at 7-12 and 9-15 months in A and B groups, respectively. Three revaccination doses were administered to non-responders whose anti-HBs titers were under 10 mIU/ml; revaccinated infants were retested at 1-3 months after last vaccination. The association between HBeAg seropositivity of mother and the failure of HBV immunoprophylaxis was evaluated. RESULTS: The seroconversion rates after primary hepatitis B vaccination were higher in A group (94.1%) than in B group (78%, P<0.001). The seroconversion rates were high in revaccinated infants (A group non-responders: 96.9%, B group non- responders: 87.5%). The failure of HBV immunoprophylaxis was significantly associated with maternal HBeAg seropositivity (P<0.001). CONCLUSION: The seroconversion rates after primary hepatitis B vaccination were low in B group infants. Revaccination of non-responders in B group was very effective. Therefore, anti-HBs testing and revaccination of B group is very important. Revaccination of non-responders in A group was also very effective. Thus, testing the immune status of infants born to HBsAg-negative mothers even after primary hepatitis B vaccination should be considered. However, to realize this, further studies on the cost-effectiveness of anti-HBs testing in healthy full-term infants are necessary.

Infantile risk factors for obesity in preschool children / 소아과

PURPOSE: Childhood obesity is a problem that places a child at great risk for becoming an obese adult. To prevent obesity, it is important to focus on early life risk factors that may contribute to childhood obesity. The aim of this study is to find obesity-causing infantile risk factors in preschool children. METHODS: A total of 223 children aged 3 to 5 years old from Busan were the subjects of this study. We calculated their body mass index (BMI) and classified them into two groups (normal weight and overweight/obese children). Information regarding parental weight and height, mother's educational level and employment status, birth weight, feeding patterns, start time of weaning, duration of night feeding, and fosterer was obtained by using questionnaires. RESULTS: There were 68 (30.5%) overweight/obese children and 155 (69.5%) normal weight children. Overweight/obese children were significantly associated with formula milk feeding, rapid weight gain during the first 6 months, and maternal obesity (P<0.05). There were no statistical differences in paternal obesity, mothers educational level and employment status, birth weight, start time of weaning, duration of night feeding, and fosterer between the normal and overweight/obese children. CONCLUSION: Although healthy diet and regular exercise will remain the cornerstones of weight management in obese children, our data supports the view that education about maintaining a normal weight could be introduced much earlier in families with high-risk children.

Swing Door Reduction Malar Plasty Without the Need for Fixation

The zygomatic bone is one of the most important bone in forming the facial contours. Asians, especially Northeast asians, including Koreans have a very wide and protruding zygomatic bone making, they have a very rough and manly look. Most of the malar osteotomy reductions including triangular osteotomy need a fixation of the bone fragment to prevent the nonunion or malunion of the zygomatic bone or the lower margin of the bone fragment after the surgery. 76 cases were reviewed between October 2004 and August 2006 which were operated in Korean hospitals and Shanghai hospital in China. 74 of the 76 cases were done for women, and the average age was 27.5(21-38). The first osteotomy was done where the frontal process and temporal process meet with a safety zone between the orbital margin towards the oral angle. The electronic saw maintains a 45 degrees to the zygomatico-maxillary buttress with preservation of the 5mm of the outer table of the zygomatic bone. However the inner table has a greater preservation of the bone and periosteum from the osteotomy. The second osteotomy line was towards the downward-laterally at a almost 90 degree angle with a 5mm interval between the first cut starting at the zygomatic body inferior laterally. To prevent the mobility and the loss of the bone when using the electronic saw for the preauricular incision or post sideburn incision, osteotome was used. In the 76 cases followed by 2 weeks, no dropping of the buccal area was found nor unwanted anterior dropping of the buccal fat was found. The authors used triangular osteotomy method and the method of creating artificial depression through 3 partial osteotomy prior to this method. There was no inferior displacement of the bone fragment after the surgery. There was essentially no loss of the bone of the osteotomy surface due to the incomplete fracture of the osteotomy-fracture of the swing zygomatic body using the osteotome. Comparing to other operations, operating time was shorter and recovery was faster. It was economical because fixation equipments did not use. Also, it was easy to do asymmetry correction since broken bone and spicule were easily moved as an operator's intention.

A Case of Myxoid Liposarcoma / 대한피부과학회지

Liposarcomas are one of the most common soft-tissue sarcomas in adults. They usually arise in the deep soft tissues, and patients present with large painless masses. Four major types of liposarcomas are generally recognized and have epidemiologic and prognostic differences: atypical lipomatous neoplasm/well-differentiated; myxoid/round- cell; dedifferentiated; pleomorphic variants. Myxoid liposarcoma is the second most common type of liposarcoma, representing 30~40% of all liposarcomas in the extremities. We report a case of myxoid liposarcoma in a 78-year-old man who presented with an asymptomatic, firm, deep-seated mass in the lateral aspect of his left upper arm.

Reconstruction of the Acquired Facial Deformity due to Cancrum Oris Sequelae

Acquired facial deformities following cancrum oris sequelae manifested variably according to the nature of tissue necrosis. In cases that tissue loss extends over a wide area of the face, or the tissue nature is different due to congenital facial cleft, it is difficult to reconstruct with a single operation. As cancrum oris has virtually disappeared from our country, clinical report of reconstruction is also rare. We report 5 cases of facial deformities following cancrum oris sequelae. Since 1988, five adult patients(4 female and 1 male) were treated by authors. These patients, with an age ranged from 47 to 58 years, all suffered from acquired facial cleft such as facial mutilation, asymmetry. The stages of operation were from 1 to maximum of 5 operations. All surgeries achieved satisfactory results after a long-term follow-up. But one surgery in the case of palatal mucosal flap for the coverage of reconstructed maxilla alveolar bone resulted tissue sloughness, followed by osteomyelitis. Those were debrided and discarded. In conclusion, all sites of deformities were positioned around one of the oral commissures. In their past medical history, they have been suffering from measles, typhoid fever and unknown febrile illness. We diagnosed the acquired facial deformity following cancrum oris sequelae. The reconstruction of acquired facial deformity following cancrum oris sequelae were difficult due to extensive multiple tissue defects. Therefore multiple staged operations were inevitable. The authors reconstructed 5 cases of simple and complex form of facial deformity with minimum staged\ operations. All patients were satisfied functionally and cosmetically.

Correction of Cryptotia Using Combined Method of Fukuda and Onizuka

Cryptotia is a relatively common congenital anomaly in orientals. It is charaterized by obliteration of auriculocephalic sulcus and buried ear cartilage of upper pole beneath the scalp skin. In addition, there is often a posterior displacement of the superior crus of antihelix. The goals of surgical correction are the coverage of skin deficit, deepening of the auriculocephalic sulcus and the correction of deformed cartilage. Some authors stressed a tendency for the superior portion of the auricle to spring back to the original portion after surgery. We have devised a surgical method to prevent recurrence of the cartilagenous deformity using combined method of Fukuda and Onizuka. From March in 2001 to Jan, 2004, We have repaired 6 cryptotic deformities in 5 patients including one bilateral cryptotia. Between them We used combined method of Fukuda and Onizuka in 4 severely deformed cryptotic superior ear cartilage correction with satisfactory results. Single Fukuda's method was used in 2 mildly deformed cryptotias. The combined method composed of Z-plasty incision for skin releasing, and incision along the crus and then flattened the crus by mattress suture, multiple incisions in the back of the superior crus and then grafting the piece of conchal cartilage producing a splinting to hold the crus out in a smooth, curved configuration for the correction of the superior portion of the deformed ear. The results were remarkable improvement of profile in severely deformed cryptotia. And so this combined method is useful method for the correction of severely deformed cartilage in cryptotia.