Theileria buffeli infections in grazing cattle in the Republic of Korea.

Theileria infections are encountered worldwide, occasionally resulting in serious economic losses for the livestock industry. This study is an epidemiological survey of Theileria infections in Korean indigenous cattle populations in the Republic of Korea (ROK). Blood samples were collected from 100 cattle in April (n=50) (prior to pastureland grazing), and again four months later, in August (n=50) (half of the cattle put out for grazing and the other half kept in housing). All samples were tested for the presence of Theileria infection based on PCR amplification of the small subunit of ribosomal RNA gene. Twenty-two samples across the whole study were verified as positive for Theileria infection by PCR methods. In August, Theileria infection was markedly increased in grazing cattle (16/25 animals, 64%) compared with indoor cattle (4/25 animals, 16%); affected animals exhibited no clinical signs of infection. The red blood cell, hematocrit, and hemoglobin values were significantly lower in Theileriapositive cattle than in Theileria-negative cattle. Phylogenetic analysis demonstrated that the isolates from this study belonged to the T. buffeli species, and were significantly related to Types A, B, C, and E, and were distinct from T. buffeli Type D, which is known to be more pathogenic. These findings indicate that T. buffeli identified in Korean indigenous cattle have a low-to-mild pathogenicity. These results suggest that the T. buffeli infection is relatively higher in the ROK, and the infection rate may increase following grazing. Taken together, T. buffeli infection may not only be seasonally correlated, but also may be affected by management practices such as pastureland grazing.

Theileria buffeli infections in grazing cattle in the Republic of Korea

Theileria infections are encountered worldwide, occasionally resulting in serious economic losses for the livestock industry. This study is an epidemiological survey of Theileria infections in Korean indigenous cattle populations in the Republic of Korea (ROK). Blood samples were collected from 100 cattle in April (n=50) (prior to pastureland grazing), and again four months later, in August (n=50) (half of the cattle put out for grazing and the other half kept in housing). All samples were tested for the presence of Theileria infection based on PCR amplification of the small subunit of ribosomal RNA gene. Twenty-two samples across the whole study were verified as positive for Theileria infection by PCR methods. In August, Theileria infection was markedly increased in grazing cattle (16/25 animals, 64%) compared with indoor cattle (4/25 animals, 16%); affected animals exhibited no clinical signs of infection. The red blood cell, hematocrit, and hemoglobin values were significantly lower in Theileria- positive cattle than in Theileria-negative cattle. Phylogenetic analysis demonstrated that the isolates from this study belonged to the T. buffeli species, and were significantly related to Types A, B, C, and E, and were distinct from T. buffeli Type D, which is known to be more pathogenic. These findings indicate that T. buffeli identified in Korean indigenous cattle have a low-to-mild pathogenicity. These results suggest that the T. buffeli infection is relatively higher in the ROK, and the infection rate may increase following grazing. Taken together, T. buffeli infection may not only be seasonally correlated, but also may be affected by management practices such as pastureland grazing.

Botulinum toxin A for the treatment of facial hyperkinetic wrinkle lines in Koreans.

There are a number of different causes for facial wrinkle lines, such as aging, gravity, and chronic pulling of mimetic muscles on the face. Among these, pulling by mimetic muscles on the skin not only involves facial expression but also has a great role in forming facial wrinkle lines as a result of repetitive action, such as dynamic or hyperkinetic wrinkle lines. Botulinum toxin A is currently being used for eliminating facial hyperkinetic wrinkles by causing paralysis of the underlying mimetic muscles. Because there are some histologic differences between Asians and Caucasians, such as thick dermis and more abundant collagen fiber, etc., the chronic pulling by mimetic muscles on the skin is expected to affect facial wrinkles differently. Therefore, the purpose of this study was to determine the efficacy of botulinum toxin A injection in eliminating facial hyperkinetic wrinkle lines among Korean patients. This study included 38 patients and 59 injection sessions from January of 1996 to April of 1997. We used Botox containing 100 U. Toxin was diluted with 4 ml of sterile normal saline and yielded 2.5 U for each 0.1 cc. A dose of 5 to 10 U was used in each muscle. Ages ranged from 26 to 56 years. There were 33 women and 5 men included in this study. Thirty-two of the patients were followed from 3 months up to 12 months after injections. The number of injection sessions that were performed on each patient was as follows: one session, 23 patients; two sessions, 10 patients; three sessions, 4 patients; four sessions, 1 patient. The number of injections per target site among these 38 patients was as follows: lateral canthal area, 33; glabellar area, 9; forehead, 9; nasal dorsum, 5. The most common duration of effective response was about 4 months, but in eight patients the period was over 5 months. After the response, complete recovery took about 1 or 2 months. Two patients felt unsatisfied, 5 patients felt slightly improved, and 25 patients retained only a slight line and were satisfied with the results. None of the patients experienced complete removal of wrinkle lines. Adverse effects included altered facial looks or appearances, mild local swelling, and ecchymosis at the injection sites. No systemic side effects were noted. Based on these results, the injection of botulinum toxin A seems to be an effective method of eliminating wrinkle lines on the upper third of the face in Korean patients, and it was a simple and effective nonsurgical procedure.

Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants.

Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.

A comparative study of the surgical treatment of axillary osmidrosis by instrument, manual, and combined subcutaneous shaving procedures.

Between 1986 and 1996, 128 patients underwent surgery for axillary osmidrosis via en bloc removal of subcutaneous cellular tissue. The patients were followed for 6 months to 7 years (average follow-up, 25 months). The authors propose three categories in which they classified shaving procedures: instrumental shavings (N = 84), manual shavings (N = 96), and combined shaving procedures (N = 76). A modified Inaba's shaver was used in instrument shavings. Combined shaving is mixture of instrument and conventional manual shaving. All patients were asked to complete a questionnaire postoperatively. This follow-up demonstrated that 92.9% of patients who underwent instrument shaving, 95.8% of patients who underwent manual shaving, and 97.4% of patients who underwent combined shaving experienced no odor or occasional, very mild axillary odor postoperatively. Postoperative scar formation was either invisible or excellent in 92.9% of instrument shavings, and 92.1% of patients who underwent the combined procedure reported either a hairless axilla or a marked decrease of axillary hair. The total satisfaction rate in the combined procedure was 94.7%, which is a better result than the instrument (92.9%) and the manual (91.7%) shaving procedures. The wound complication rate per patient with the combined procedure was 13.2%. There was no scar contracture or limitation in arm abduction. The combined subcutaneous shaving procedure using the modified Inaba's shaver has the advantages of rapid and accurate shaving, low incidence of hematoma formation, enhanced wound healing, and easy postoperative care. Therefore, en bloc resection of subcutaneous cellular tissue by combined shaving is a viable option for treatment of axillary osmidrosis.

Endoscopic application in aesthetic and reconstructive facial bone surgery.

Twenty-three cases of endoscopically assisted facial bone surgery were performed over the past 3 years. Our series is consistent with 16 cases of aesthetic contouring surgery and 12 treatments of facial bone fracture, including three cases for recontouring of frontal bone, three cases for recontouring of zygoma, endoscopically assisted correction of three zygomatic and blowout fractures, four cases for rhinoplasty and septoplasty for deviated nose, and three cases for mandible contouring surgery. To accomplish this technique, a rigid 4-mm, 30-degree down-angled endoscope was used. The frontal bone or zygomatic arch was approached endoscopically through two or three small incisions on the frontal or temporoparietal scalp. All endoscopic instruments were then manipulated through these incisions. The approach for endoscopically assisted rhinoplasty is the same as with standard rhinoplasty procedures. The approach for zygoma complex and maxillary sinus needs an intraoral incision. Recontouring of zygoma, mandible, and nasal dorsum by an air-driven burr and rasp was performed with endoscopic visual assistance. A plate and screw fixation for zygomatic arch fracture requires an additional small skin incision over the plate for the trocar method. The duration of follow-up ranged from 6 months to 30 months. The postoperative course was satisfactory with a few complications. The extra time needed for the endoscopic procedures was less than 1 hour. Endoscopically assisted facial bone surgery can be performed with adequate visualization and direct manipulation of all facial bones. Complications usually associated with extensive incisions in the bicoronal approach may be avoided. Poor visualization in the conventional approach for operation of orbit, nose, maxillae, and mandible may be avoided by use of the endoscope. This technique may prove to be ideal for aesthetic surgery for facial skeleton with smaller scar and less morbidity.

Endoscopic-assisted correction of the deviated nose.

The approach to nasal bone classic corrective rhinoplasty is an almost-blind technique, where the results depends on feeling by the surgeon's hand. To overcome these drawbacks, endoscopic-assisted corrective rhinoplasty and septoplasty were performed for 16 cases of deviated noses between January 1995 and May 1997. The average follow-up period was 18 months. All patients were evaluated by symmetrical nasal pyramid, recurrence of the bony deflection, and septal deviation. The postoperative courses were satisfactory in most cases, with few complications. Compared with 28 cases of classic rhinoplasty, the patient satisfaction rate was high (87.5% in endoscopic-assisted rhinoplasty, 71.4% in classic rhinoplasty), and the complication and revision rate was low (0% in endoscopic-assisted rhinoplasty, 14.3 and 7.1% in classic rhinoplasty). But extra time (about 40 min) and greater expense were required for endoscopic-assisted rhinoplasty. It appeared to us that endoscopic control during corrective rhinoplasty and septoplasty is a big step toward obtaining better results in bony and cartilage resection with extreme precision under monitor control and magnification. This technique is not an open approach but permits one to see more of the nasal skeleton and bony septum, the cause of the deformity, and the immediate effect of the corrective measures used. The use of an endoscope in corrective rhinoplasty for deviated noses provides an expanded field of vision, direct manipulation of lesions, and better aesthetic and functional results.

Use of laser Doppler flowmetry for estimation of the depth of burns.

The trend for treatment of deep second degree burns and third degree burns is toward early excision and skin grafting. The ability to predict burn depth accurately as early as possible is important for early excision and skin grafting. This study, prospectively evaluated the ability of laser Doppler flow measurements, obtained within 72 hours after burn injury, to predict the depth of burn wounds. A Periflux system 4001 laser Doppler flowmeter was used to measure the cutaneous microflow circulation of 100 selected points of burn wounds on 44 inpatients and of 1680 selected points on 120 volunteers from March of 1993 to February of 1994. The mean value of superficial second degree burns checked by laser Doppler was 194.6 perfusion units (PU). The value of deep second degree burns was 59.7 PU, and the value of third degree burns was 5.1 PU. The mean normal cutaneous blood flow of 120 volunteers (control group) was between 4 and 9 PU, except on the head, neck, hand, and foot. Blood flow of more than 100 PU correctly predicted (90.2 percent of cases) a superficial second degree burn. Blood flow between 100 and 10 PU correctly predicted (96.2 percent of cases) a deep second degree dermal burn. That of less than 10 PU correctly predicted (100 percent of cases) a third degree burn. There was also a significant correlation between initial flow measurements and the depth of burn wounds. We conclude that laser Doppler flow measurements performed early after burn injury are useful in predicting the depth of burn wounds. Laser Doppler flowmetry has the advantage of being easy to use and noninvasive and of providing immediate results for early determination of burn depth. Laser Doppler flowmetry is useful in selecting patients for early excision and grafting of burn wounds.

Low total body bone mineral content and high bone resorption in Korean winter-born versus summer-born newborn infants.

Seasonal differences in newborn total body bone mineral content (TBBMC) have not been studied, particularly in relation to alterations in vitamin D status in winter. In vitamin D deficiency bone resorption may be high and bone mineralization low. Bone resorption may be assessed by serum cross-linked carboxyterminal telopeptide of type I collagen (ICTP) measures. Because vitamin D supplements throughout pregnancy are uncommon in Korea, we hypothesized that in Korean winter newborns, TBBMC is low and serum ICTP high from high bone resorption and low 25-hydroxyvitamin D (25-OHD) compared with those in summer newborns. Seventy-one Korean term infants were studied prospectively in summer (July through September, n = 37) versus winter (January through March, n = 34); TBBMC was measured before 3 days of age by dual-energy x-ray absorptiometry. Significant seasonal differences were found: winter newborns had 6% lower TBBMC (least squares means +/- SD; 86.7 +/- 7.7 gm vs 93.9 +/- 7.8 gm, p = 0.0002), lower cord serum 25-OHD (10.7 +/- 8 nm vs 30 +/- 15 nm, p = 0.0001) and 1,25-dihydroxyvitamin D, and higher ICTP (96.4 +/- 20.3 microg/L vs 74.8 +/- 24 microg/L, p = 0.0002) and calcium than summer newborns. TBBMC correlated with serum 25-OHD (r = 0.243, p = 0.047) and inversely with ICTP (r = -0.333, p = 0.008). We suggest that in Korea low maternal vitamin D status in winter results in marked reduction in newborn TBBMC.

Blepharoptosis repair by selective use of superiorly based muscle flaps.

Thirty-three patients with severe blepharoptosis were treated by the superiorly based orbicularis oculi muscles, interdigitated orbicularis oculi-frontalis muscle flaps, or frontalis muscle flaps. The superiorly based muscle flaps are modifications of direct transplantation of the frontalis muscle to the tarsal plate on the basis of anatomic study that the frontalis muscle and its fascia are connected with the orbicularis oculi muscle at the eyebrow region. The selection of muscle flaps is based on the extent of levator function of patients. When eyelid excursion is moderate (3 to 5 mm), the orbicularis oculi muscle flap technique was effective. For patients with weak eyelid excursion (2 to 4 mm), the interdigitated orbicularis oculi-frontalis muscle flap was the procedure of choice. For patients with minimal eyelid excursion (less than 2 mm), frontalis muscle flap technique is indicated. The majority of patients recorded as satisfactory results according to the criteria of Souther and Jordan after an average follow-up period of 18.5 months. Even though four patients showed undercorrection, there has been no complete failure or laxity of the advanced flaps in our series. The orbicularis oculi muscle technique or the interdigitated orbicularis oculi-frontalis muscle flap technique offers several advantages over the conventional frontalis muscle flap technique, such as being a simple technique with a good operative field, single incision on supratarsal fold, no depression on the forehead, no risk of neurovascular injury, and relatively easy technique with less complication. The frontalis muscle flap technique is better in patients with less than 2-mm eyelid excursion to avoid recurrence even if the superiorly based frontalis muscle flap technique has some inherent shortcomings.

Mapping of the human body skin with laser Doppler flowmetry.

The purpose of this study was to evaluate cutaneous blood flow in the human body to better establish normal flow ranges and to determine whether the location, side of the body, sex, and age affect the flow range at seven different sites. From March 1993 to February 1994 a Periflux system 4001 laser Doppler flowmeter was used to measure the cutaneous microflow circulation of 1,680 selected points in 120 volunteers. The mean normal cutaneous blood flow of 120 volunteers was between 4 and 9 perfusion units (PU) except in the head, neck, hand, and foot. Mean cutaneous blood flow measurements were as follows: the upper arm, 6.6 +/- 1.20 PU (mean +/- SE); the forearm, 6.7 +/- 1.95 PU; the thorax, 7.1 +/- 1.72 PU; the flank, 6.3 +/- 1.23 PU; the abdomen, 5.3 +/- 1.79 PU; the thigh, 4.8 +/- 1.34 PU; the lower leg, 4.6 +/- 1.39 PU (p < 0.05). The blood flow of the thorax was highest and was 54% higher than the lower leg. The group of teenagers had the highest cutaneous blood flow, with an average value of 6.9 +/- 0.62 PU. The group of subjects in their sixties proved to have the lowest cutaneous blood flow-32% less than the teenagers. Gender differences were not noted. There were no significant differences in blood flow in regard to the side of the body.

Congenital cytomegalovirus infection in Korean population with very high prevalence of maternal immunity.

In order to asses congenital cytomegalovirus (CMV) infection in Korea, five hundred and seventy five pregnant women (mean age 29.5 +/- 3.8 yrs., mean gestational age at test 37.5 +/- 6.7 weeks) visiting the prenatal clinic at Severance Hospital, Seoul, Korea were studied. CMV IgG antibody was present in 96% (552/575) and IgM antibody was present in 0.7% (4/575) of the pregnant women by the third trimester. Four of 445 cord sera were positive for CMV IgM antibody (0.9%). Urine samples from 514 newborns were tested for the evaluation of congenital CMV infection. Six (1.2%) of 514 newborns excreted CMV in their urine. All the congenitally infected infants had subclinical involvement at birth and during the 12 months of the follow-up period. These results indicate that Korean pregnant women were highly immunized against CMV by the third trimester. Furthermore this study suggests that the rate of congenital CMV infection is relatively as high as rates previously reported from other countries, although there is a very high prevalence of maternal immunity. The incidence of maternal primary infection during pregnancy seems to be rare and therefore most congenital infections in Korea might be following by maternal reactivation or reinfection.

Effect of tolazoline on persistent hypoxemia in severe hyaline membrane disease.

Ten critically-ill preterm infants with severe hyaline membrane disease received tolazoline because of persistent hypoxemia refractory to the administration of 100% oxygen and mechanical ventilation. Seven infants (70%) responded immediately with an increase in PaO2 greater than or equal to 20 mmHg in the umbilical arterial gas within 60 minutes after bolus infusion (1 to 2 mg/kg) of tolazoline. Twenty-four hours later after the tolazoline infusion, the FiO2 had been decreased from 1.0 to a mean of 0.82 +/- 0.16, and the MAP from 16.5 +/- 1.8 to 15.6 +/- 4.5 cm H2O. Four of 7 infants (57%) who had an immediate response survived, whereas none survived out of 3 infants who failed to respond initially. Three infants experienced relatively severe complications possibly related to tolazoline. There appears to be a place for the use of tolazoline in a severely hypoxemic infant with hyaline membrane disease who is being ventilated, and in whom arterial oxygenation cannot be improved by a further increase in the inspired oxygen concentration or by an alteration of ventilator settings.

Exogenous surfactant replacement therapy of hyaline membrane disease in premature infants.

We conducted a clinical trial to assess whether surfactant-TA given within the first six hours of life could improve oxygenation and reduce the ventilatory support in premature infants with hyaline membrane disease (HMD) during the first 24 hours of life. Eight premature infants with severe HMD requiring ventilation were treated, at a mean age of 2.72 hours, with a single intratracheal instillation of surfactant-TA (120 mg/kg). Arterial oxygenation improved dramatically as reflected by the increase of the a/A PO2 ratio and PaO2 to about 2 times the pretreatment values within 3 hours after surfactant treatment. And thus, oxygen concentrations (FiO2) could be reduced and remained significantly lower than pretreatment values during the first 24 hours after treatment. Infants given surfactant-TA required lower mean airway pressure (MAP) and had a significantly decreased ventilatory index (VI) during the first 24 hours after treatment, which reflect the decreased requirement for ventilatory support. Chest radiograph scores significantly improved within 24 hours after treatment compared with pretreatment scores. In this trial, we found that a single intratracheal dose of surfactant-TA given to infants with HMD resulted in improved respiratory status and radiographic findings during the first 24 hours after treatment.