An Innovative Scalp-Dyeing Technique with Gentian Violet Solution During Follicular Unit Extraction for White-Haired Follicular Units

There exist some restrictions and difficulties in performing follicular unit extraction (FUE) in white-haired patients, for several reasons. In this paper, we introduce a novel technique for visualizing white hair during the punching procedure and graft preparation in FUE for white-haired patients. In white-haired older male patients, we dyed the surrounding scalp skin purple with a gentian violet solution-stained toothpick. Our method has several advantages: surgeons can easily focus on the center of the follicular unit and rapidly perform punching, they can recognize the condition of the harvested follicular units during FUE, and the hair transplant team can secure a clear view for trimming and loading into the implanter. We suggest that scalp dyeing in difficult FUE procedures, especially in patients with white hair, may be a simple method that provides a good visualization for donor site harvesting and for microdissection.

The Usefulness of Different Injury Scoring Systems in Trauma Patients with Altered Mental Status

PURPOSES: The causes of altered mental status (AMS) are varied. Trauma accounts for 6.5%-36.3% of all AMS cases, and the mortality in these instances ranges from 20~80.5%. Multiple injury severity scoring systems exist to assist in the prognosing of trauma patients. We investigated the degree of correlation between injury severity scoring systems and prognoses of patients with AMS due to trauma. METHODS: We reviewed the medical records of 188 patients admitted to the emergency department of Konyang University Hospital who had trauma with AMS. We investigated the clinical characteristics of these patients and evaluated the usefulness of four injury severity scoring systems: revised trauma score (RTS), injury severity score (ISS), new injury severity score (NISS), and trauma and injury severity score (TRISS). RESULTS: The average scores of ISS and NISS were higher and RTS and TRISS were lower in the non-survivor group than in the survivor group (p<0.01). The area under the curve (AUC) for the receiver operating characteristic (ROC) curve was 0.725 for ISS and 0.733 for NISS, but these scoring systems had only a fair predictive ability. Hosmer-Lemeshow statistics showed no predictive ability differences for death between the four scoring systems. The predictive ability of all injury severity scoring systems to identify survivors was high (88.1~94.0%). In contrast, their predictive ability to identify non-survivors was low (29.6%~63.0%). CONCLUSIONS: In the use of RTS, ISS, NISS, and TRISS for evaluating trauma patients with AMS, none of the four systems exhibited any distinguishing predictive features. All failed to reliably predict non-survivors, but all showed good predictive value for identifying survivors.

A Study of Facial Fracture and Associated Injuries

PURPOSE: This study is to analyze the frequency and pattern of associated injuries in patients with facial fractures. METHODS: A retrospective method was used to study facial fracture patients visiting our emergency room from May 2002 to April 2003. The patient's age, sex, injury mechanism, location of facial fracture, and associated injuries, as well as the records of emergency procedures and emergency operations were examined. RESULTS: During the research, a total number of 206 patients with facial fractures were examined. As for the injury mechanism, traffic accidents were the primary cause with 40.3%. Orbital fracture was the most common overall facial fracture (44.7%). Ninety-seven (47.1%) patients had associated injuries. Fifty-nine of those patients had head injuries, 48 had extremity injuries, 17 had chest injuries, 14 had abdominal injuries, and 13 had spine injuries. Among the facial-fracture patients, patients with maxillary fractures had the most associated injuries (95.3%). Of those associated injuries, head injuries were the most commonly reported ones (48.3%). The emergency procedures used were intubations (9) and thoracostomies (4). The emergency operations performed were craniotomies (5) and exploratory laparotomies (2). Four patients died due to brain injuries. CONCILUSION: Associated injuries often occur in patients with facial fractures. Head and extremity injuries are the most common associated injuries. We believe emergency physicians can maximize the effectiveness of their treatment of patients with facial fractures and their associated injuries through a coordinated team approach, while minimizing the complications and sequelae.

Intramuscular Hemangioma of the Mentalis Muscle: A Case Report

Intramuscular hemangiomas are uncommon tumors of the head and neck, consistituting of 0.8% of all hemangioma, but often occur in the trunk and extremities. In the head and neck area, the masseter and trapezius muscle occur frequently, in which diagnosis is often difficult even with accurate preoperative imaging. The definitive diagnosis is made by histological study of the surgical biopsy specimen. Treatment of choice is complete surgical excision. This is, to our knowledge, the first case of intramuscular hemangioma of the mentalis muscle to be reported in korea.

Lipolytic Activity and Cytotoxic Effect of Aminophylline in Adipocytes

A concern about drug therapy for obesity has been increased with launching of new anti-obesity drug in Korea. Subcutaneous injection of aminophylline was used for regional lipolysis, but its effectiveness and safety are controversial. The purpose of this study is to investigate the effects of aminophylline on lipolytic activity and cytotoxic effect in adipocytes. Preadipocytes obtained from human breast fat tissue were cultured in monolayer culture system. Cells were treated with media added 1, 5, 10, 15, 25 mM aminophylline concentrations, respectively. Cytotoxicity was measured by XTT colorimetric assay and cell count. The lipolytic activity was measured by enzymatic autoanalyzed system. At above 15mM of aminophylline concentration, preadipocyte and adipocyte markedly presented cytotoxic effects. In proportion to concentration, lipolytic activity was increased and maximal lipolytic activity without marked cytotoxicity was measured at 10mM of aminophylline concentration.

Treatment of the Medial Orbital Wall Fracture using Transcaruncular Approach

Medial orbital wall fracture can easily be overlooked because typical clinical symptoms appear in only a few instances. However, if it is left untreated in case of no diplopia, cosmetically undesirable enophthalmos may develop. Various cutaneous approaches, previously used, may leave noticeable scar or provide a limited overview of the orbit medial wall fracture site. We used the transcaruncular approach in 36 cases of 35 patients for reconstruction of the medial orbital wall fracture. The incision was made at the junction of the medial 3/4 and lateral 1/4 of the caruncle, and extended along the conjunctival fornix superiorly and inferiorly to or beyond both puncta for 10 - 15 mm long respectively. After soft tissue was dissected, periosteum was incised at the posterior to the posterior lacrimal crest. Implants up to a height of 2.5 cm could be inserted.The diplopia was resolved in all cases after the surgery, and enophthalmos measured 0 to 2 mm in all patients. Postoperative computed tomographic scans showed favorable reduction of the herniated soft tissues and anatomic reduction of the medial wall without complication related to the surgical approach in all cases. Transcaruncular approach is a better alternative to transcutaneous incisions because it provides wide exposure of the medial orbital wall, no visible cutaneous scar, short operation time, and no damage of important internal structures.