Analysis of Facial Asymmetry in Deformational Plagiocephaly Using Three-Dimensional Computed Tomographic Review

BACKGROUND: Infants with deformational plagiocephaly (DP) usually present with cranial vault deformities as well as facial asymmetry. The purpose of this study was to use three-dimensional anthropometric data to evaluate the influence of cranial deformities on facial asymmetry. METHODS: We analyzed three-dimensional computed tomography data for infants with DP (n=48) and without DP (n=30, control). Using 16 landmarks and 3 reference planes, 22 distance parameters and 2 angular parameters were compared. This cephalometric assessment focused on asymmetry of the orbits, nose, ears, maxilla, and mandible. We then assessed the correlation between 23 of the measurements and cranial vault asymmetry (CVA) for statistical significance using relative differences and correlation analysis. RESULTS: With the exception of few orbital asymmetry variables, most measurements indicated that the facial asymmetry was greater in infants with DP. Mandibular and nasal asymmetry was correlated highly with severity of CVA. Shortening of the ipsilateral mandibular body was particularly significant. There was no significant deformity in the maxilla or ear. CONCLUSION: This study demonstrated that the cranial vault deformity in DP is associated with facial asymmetry. Compared with the control group, the infants with DP were found to have prominent asymmetry of the nose and mandible.

Surgical Correction of an Accessory Auricle, Polyotia

No abstract available.

Retrospective Comparisons about Effects of Angiotensin II Receptor Blocker and/or Steroid on Proteinuria Reduction and Renal Protection in IgA Nephropathy Patients with Proteinuria less than 1 g/g / 대한신장학회지

PURPOSE: It remains controversial how to treat the IgA nephropathy (IgAN) patients with proteinuria <1g/day. We investigated effects of single or combined use of angiotensin II receptor blocker (ARB) and steroid on proteinuria reduction and renal protection in IgAN patients with normal renal function and urine protein/creatinine ratio (PCR) < or =1 g/g. METHODS: Oral prednisolone was given at an initial dose of 1 mg/kg every day for 2 months and then gradually tapered for 4 months. An ARB irbesartan or losartan or valsartan was given until the end of follow-up. RESULTS: Over a mean follow-up period of about 40 mo, the urine PCR decreased from 0.64+/-0.29 g/g to 0.32+/-0.31 g/g in the combination group (n=26) (p<0.05). But in ARB (n=17) and steroid groups (n=20), it decreased from 0.56+/-0.26 g/g to 0.54+/-0.45 g/g and from 0.50+/-0.26 g/g to 0.34+/-0.32 g/g, respectively, while there were no statistical significances. Serum creatinine decreased from 0.83+/-0.13 mg/dL to 0.73+/-0.14 mg/dL in steroid group (p<0.01), and from 0.92+/-0.17 mg/dL to 0.81+/-0.23 mg/dL in combination group (p<0.01). But in ARB group, no statistical significance was noticed. All patients achieved the BP goal < or =130/80 mmHg by adding anti-hypertensive drugs, if necessary. CONCLUSION: Our results indicate that (steroid or) combination therapy reduced proteinuria and improved renal function in the patients with proteinuria < or =1 g/g. Further prospective controlled studies are required to clarify the effect of steroid over the long term.

The Effect of Conversion from Cyclosporine to Tacrolimus in Renal Allograft Recipient with Hyperlipidemia / 대한신장학회지

PURPOSE: Management of cardiovascular risk factors is of major importance in renal transplant recipients to determine long-term outcomes. While calcineurin inhibitors improve the clinical course after kidney transplantation, they have been implicated in contributing to increased cardiovascular risk. This study investigated the influence of conversion from cyclosporine to tacrolimus on cardiovascular risks and graft function in renal allograft recipients with hyperlipidemia. METHODS: Twenty three adult renal recipients who were receiving cyclosporine-based regimen for more than one year after transplantation and had hyperlipidemia (serum total cholesterol > or =200 mg/dL) were enrolled. The effect of conversion from cyclosporine to tacrolimus was evaluated with blood pressure, fasting lipid profile, glucose and HbA1c. They were measured at baseline and at 1, 3, 6 and 12 months after conversion. The change in estimated glomerular filtration rate (eGRF) was also compared between before and after conversion. RESULTS: Though conversion from cyclosporine to tacrolimus did not cause significant differences in the serum triglyceride level, there was a noticeable decline in total cholesterol level (213.78+/-16.28 to 185.96+/-38.62 mg/dL, p<0.01). Conversion did not trigger new onset or worsening of diabetes mellitus with no meaningful differences in fasting blood glucose and HbA1c levels. The eGFR stabilized with Tacrolimus in comparison with the cyclosporine (-2.9+/-13.4 mL/min vs. -7.3+/-13.8 mL/min). CONCLUSION: Conversion to tacrolimus would be preferable to cyclosporine for maintenance immunesuppression in renal recipient with hyperlipidemia, as it meliorates hyperlipidemia and leads to stabilization of allograft function.

Hypoglycemia-induced Dementia and MR Image-irreversible Restricted Diffusion in Splenium of Corpus Callosum: A case report

The clinical impact of severe hypoglycemic brain insult is ranged from alterations of mental status to profound coma and death. However, the exact mechanism of hypoglycemic brain insult is not well known yet. We report a case of a 75-year-old female with diabetes, who developed dementia after a severe hypoglycemic event. Diffusion-weighted magnetic resonance imaging detected an increased signal intensity in the splenium of corpus callosum. After 6 days, follow-up MRI (T2 weighted imaging) revealed irreversible signal abnormalities in the splenium of corpus callosum. Also, SPECT (Single Positron Emission Computed Tomography) and PET (Positron Emission Tomography) revealed decreased cerebral functions in left parietal, temporal and occipital lobes. This case brings up better understanding for the extent and mechanism of hypoglycemic brain insult.

Glucose Pump Technique is as Good as Ultrasound Dilution Technique for Vascular Access Surveillance in Hemodialysis Patients / 대한신장학회지

PURPOSE: Vascular access flow (Qa) measurements are important in the surveillance protocol of hemodialysis vascular access stenosis. The glucose pump technique (GPT) is a technique for Qa measurement based on the dilution technique of a constant glucose infusion that was introduced in 1995. The aim of this study is to verify the clinical efficacy of GPT in vascular access surveillance compared with ultrasound dilution technique. METHODS: In 31 chronic hemodialysis patients with a AV fistula, we compared Qa measurements performed with GPT in pre-dialysis and the ultrasound dilution technique (Transonic HD01, Transonic System Inc., Ithaca, NY) during hemodialysis. RESULTS: Mean Qa was 1171 ml/min by GPT versus 1028 ml/min by HD01 (p=0.262). There was a strong linear correlation between the two methods (r=0.61; p<0.01). Ultrasound dilution technique HD01 yielded 6 cases of high risk Qa measurements and GPT yielded 4 cases of high risk Qa measurements. The diagnostic accuracy of GPT tested with the ROC curve was similar with ultrasound dilution technique HD01. The specificity and sensitivity was 80% and 66.7% according to Qa=600 ml/min. But sensitivity was 83.3% according to Qa=750 ml/min. CONCLUSION: GPT offers the advantage of a simple and economic bedside procedure easily performed before dialysis and had a similar diagnostic accuracy and efficiency compared with ultrasound dilution technique HD01.

Congenital Anomalies of Aortic Arch: CT Angiography

Aortic arch anomalies result from the failure of an embryonic vascular structure to persist and regress in the usual manner during formation of the aortic arch. The anomalous aortic arch may encircle and compress the trachea and esophagus as a form of a vascular ring. The diagnosis of aortic arch anomaly and the recognition of airway compression are important because they are conditions which complicate the natural and surgical course of related diseases. CT can demonstrate the nature of anatomic structures such as the trachea and esophagus not revealed by angiography, simultaneously disclosing the relationship of stenotic airways and offending mediastinal vessels. Volumetric data acquisition by means of spiral CT enables three dimensional reconstruction,which can provide easy global understanding of the complex anatomy and spatial relationship of airway and cardiovascular structures. Three dimensional imaging is very useful for the physician and surgeon who are not accustomed to mentally reconstructing axial images, and can facilitate surgical planning.

Coronary Angiographic Findings of Left Atrial Thrombi in Mitral Stenosis

PURPOSE: To investigate the coronary angiographic findings of left atrial thrombi associated with mitral stenosis. MATERIALS AND METHODS: In 98 patients who had undergone coronary angiography and in whom the presence of left atrial thrombi was confirmed by surgery or repeated transesophageal echocardiography, evaluated the pattern, origin and location of abnormal vasculature suggestive of left atrial thrombi such; abnormalities included neovascularity, staining, dye collection and fistula. RESULTS: Abnormal vasculature was observed in 70 patients (71.4%). It arose from the left circumflex artery in 66 patients (including the sinus nodal branch in four), the right coronary artery in 14 (including the sinus nodal branch in 7 and conal branch in 2), the left anterior descending artery in one, and the left main coronary artery in one. The patterns of abnormal vasculature arising from the left coronary artery were fistula in 50, dye collection in 32, staining in 29 and neovascularity in 24; those arising from the right coronary artery were fistula in four, dye collection in two, staining in four and neovascularity in nine. Abnormal vasculature located at the anterior third of the left atrium in 50 cases, the middle in 20, and the posterior region in 12. CONCLUSION: The abnormal vasculature suggested by left atrial thrombi most commonly arose from the left circumflex artery and was located at the anterior one-third of the left atrial cavity. Fistula was the most common finding of left atrial thrombi, and for that these detection of the abnormal vasculature thrombi give rise to, selective coronary angiography was the useful modality.

A Clinical Analysis of the Treatment of Primary Varicose Vein of the Lower Limbs

BACKGROUND: Primary varicose veins are caused by a retrograde blood flow and increased hydrostatic pressure as a result of an increase in height or in physical strain associated with work. Treatment for varicose vein involves 1) conservative management - periodic leg elevation, elastic stocking support, and exercise with stocking support, 2) sclerotherapy, and 3) surgery. METHODS: Ninety-two limbs with primary varicose veins of the lower limb were operated on from Jan. 1996 to Dec. 1996. RESULTS: The prevalent age group consisted of those patients between 50 and 60 years old, and the female to male ratio was 2 : 1. Varicose veins developed in the right lower limb in 48 cases, in the left lower limb in 37 cases, and in both lower limbs in 7 cases. Presumed etiological factors included occupations requiring long periods of standing in 13 male cases, and pregnancy in 26 female cases. The average duration of illness was 12.5 8.6 years. Of the 92 cases operated on, a greater saphenous vein (GSV) high ligation (HL) and above knee (AK) stripping with varicosectomy (VS) was done in 38 cases, a GSV HL and total stripping with VS in 4 cases, a short saphenous vein (SSV) HL and VS in 14 cases, an external banding valvuloplasty of GSV and VS in 29 cases, an external banding valvuloplasty only in 2 cases, a Linton's operation in 2 cases, a GSV branch ligation and VS in 1 case, and sclerotherapy in 2 cases. The reduction rates of venous volume (VV) and ambulatory venous pressure (AVP) were 15 19% and 33 33%, respectively, after stripping. The reduction rates of VV and AVP were 19 18% and 33 36%, respectively, after valvuloplasty. Postoperative complications were wound complication in 1 case in the AK stripping group; postoperative numbness in 3 cases and wound complication in 1 case in the total stripping group; and wound complication in 1 case, GSV thrombosis in 2 cases, postoperative bleeding in 1 case, and postoperative reflux in 1 case in the valvuloplasty group. CONCLUSIONS: Generally, postoperative conditions were good and complications were negligible. In the stripping group, postoperative numbness developed only in the total stripping group. Between the valvuloplasty and the stripping groups, there was no significant hemodynamic difference.

Angiographic Evaluation of Coronary Arterial Abnormalities in Kawasaki Disease

PURPOSE: To evaluate the coronary angiographic findings of patients with Kawasaki disease and to investigatethe natural course of aneurysms of the coronary artery. MATERIALS AND METHODS: Between June 1989 and January1996, we evaluated the coronary angiographic findings of 12 consecutive children with Kawasaki disease whosecoronary artery was abnormal. On initial study, we retrospectively analysed the size, configuration, and locationof 35 coronary aneurysms, and in five children, follow-up coronary angiography was performed at intervals of 17 to28 (mean, 23) months. Seventeen aneurysms detected on initial study were evaluated for subsequent change. RESULTS: Initial coronary angiography showed the aneurysms to be diffuse in 7 cases(20%), saccular in 7(20%), fusiform in17(49%), and tubular in 4(11%). They were large in 10 cases (29%), medium in 22(63%), and small in 3(9%) ; theirlocation in the coronary artery was proximal(71%), middle in 6(17%), and distal in 4(11%). The right coronaryartery was involved in 18 case(51%), and the left coronary artery in 17(49%). Follow-up study showed that theaneurysm had regressed in 11 cases (65%), persisted in 2(12%), and progressed to stenosis in 1(6%) and occlusionin 3(18%). Two(50%) of the four large aneurysms showed complete occlusion. On the other hand, medium and smallaneurysms showed regression in 9(82%) and in all cases, respectively. Diffuse-type aneurysms were complicated byocclusion in 2 cases (50%) and stenosis in 1(25%). On the other hand, six fusiform aneurysms (75%) and allsaccular and tubular aneurysms had regressed. CONCLUSION: In patients with kawasaki disease, informationregarding the size and configuration of coronary aneurysms may be useful for predicting the natural course andprognosis of coronary artery disease.

Characteristics of Vascular Anatomy and Hemodynamics in Korean Population

The value of the noninvasive diagnostic methods for vascular disease is worthy of emphasis. In many studies, the diagnostic abnormal findings of the vascular disease were reported. But there were a few studies for normal human vasculatures measuring with noninvasive diagnostic methods. And more, there is few data for vasculature of Oriental people, especially of the Korean population. The authors examed 20 healthy persons without any vascular disease by using the noninvasive vascular diagnostic tool-duplex scan and air plethysmography. The knowledge of the normal data of human vasculature, especially Korean population, will improve the sensitivity and specificity of the noninvasive vascular diagnostic methods. It is not appropriate to presume that this report with analysis of only 20 cases represent the normal data of Korean population. Further collection of the data is needed to define the normal data of vasculature of Korean population.