What is like to be a devoted doctor? An analysis of book reports on The Painted Veil.

PURPOSE: The aim of this study is to see what medical students think about the role of spouse of a devoted medical doctor through the book reports of The Painted Veil (1925). METHODS: The 53 medical students were asked to read Maugham's The Painted Veil and to have a discussion. In their book reports, following questions were asked to be included: What it is like to be married a devoted medical doctor? Do you think that patients realize, value, and respect the importance of doctor's work? In the outbreak of highly infectious and fatal disease, can you carry out a heroic fight to control it? RESULTS: Among the 53 respondents, seven students (13%) answered that they would be happy if they marry a devoted doctor and scientist and 34 (64%) unhappy. The remaining 12 (23%) could not make a decision. The six students (11%) answered that doctor is valued and respected by patients while 46 (87%) answered doctor is neither valued nor respected. The remaining one (2%) could not decide. The 20 students (38%) answered that they would fight for the infectious disease and the remaining 30 (57%) answered that they would not. The remaining three (5%) could not determine their mind. CONCLUSION: The Painted Veil induced a virtue of "life of balance and harmony" and "attitude of doctor who give superiority to responsibility and duty over prestige and wealth" from the medical students. It could be a good teaching material for medical humanity.

The God of Mercy or the King of the Hell? Plastic Surgeon Depicted in Parodies of Altar Portraits of Buddha.

The aim of this paper is to see how the plastic surgeons are depicted in some recently made parodies of altar portraits of Buddha. Three of Kim's traditional paintings depicting a plastic surgeon were collected and 3 types of altar portraits of Buddha were also collected. The Water-Moon Avalokiteshvara (Symbol: see text) sits on a rocky outcropping above the waves. At the lower right, is the boy pilgrim Sudhana (Symbol: see text). In the "Plastic Surgeon as a Bodhisattva," the plastic surgeon is wreathed in gold necklaces and seated on stones as if he were a wise man or perhaps a divine being, only it is his services that help allow for transformation. Below him, there is a female who yearns for man-made beauty. In Emma's court, there is a "Mirror of Perfect Clarity" that reflects unfailingly, the past misconduct and sins of the dead. In "Judgment of the Obese" (Symbol: see text), the plastic surgeon looks down on his patients from above and makes severe judgments about their looks. The women are holding their hands out desperately, standing haggard in front of the mirror, pleading to the doctor. The Great Master of Seon Buddhism holds a large fly-whisk. In the "Portrait of a Plastic Surgeon" (Symbol: see text), a surgeon is sitting in a chair holding a huge surgical knife as if the patriarch holds a monk's stick. Like the patients at our clinic and the sole of the dead at the Emma's court, we plastic surgeons should have a "Mirror" to reflect our practices and ask ourselves whether we are "good" doctors or not.

Anatomy of the tenth costal cartilage for a columella strut in an Asian rhinoplasty.

The aim of this study was to elucidate the precise radiological and surface anatomy of the 10th costal cartilage for the usage of a columella strut in an Asian rhinoplasty.Three hundred abdominal computed tomography scans were reviewed and measured (166 males, 134 females), and the location of the 10th costochondral junction (CCJ) was measured in reference to the anterior superior iliac spine (ASIS) and umbilicus. Sixteen 10th costal cartilages were harvested from 10 Korean adult cadavers (7 males, 3 females), and the length, width, and thickness of each cartilage were measured.Distance from the anterior ASIS to the umbilicus was 155.4 ± 15.1 mm (male: 157.9 ± 15.5 mm, female: 152.2 ± 14.1 mm). Distance from the umbilicus to the 10th CCJ was 170.7 ± 23.0 mm (male: 179.2 ± 22.8 mm, female: 160.3 ± 18.7 mm). Distance from the ASIS to the 10th CSJ angle was 181.8 ± 21.8 mm (male: 184.7 ± 21.3 mm, female: 178.2 ± 22.1 mm). The ASIS-umbilicus-10th CSJ angle was 56.3 ± 5.6 degrees (male: 55.1 ± 5.5 degrees, female: 57.8 ± 5.3 degrees). The average length of the cartilage was 64.1 ± 19.7 mm. The average curved length of the cartilage was 69.6 ± 21.0 mm. The average greatest width was 11.0 ± 2.1 mm, and the width at its mid-length was 8.3 ± 1.7 mm. The average thickness of the cartilage was 5.7 ± 0.9 mm. In a 33-year-old woman, the 10th costal cartilage was used for columella strut.It is thought that the 10th costal cartilage can provide a sufficient amount and shape for a columella strut and tip in an onlay graft.

Particle size, temperature, and released amount of fat for safe periorbital fat grafts.

The aim of this study was to determine the particle size, temperature, and amount of released fat for safe periorbital fat grafts. From 28 patients, fat was suctioned from the abdomen (large particles [LPs]) and from the inner thigh (small particles [SPs]) using a 2.1-mm harvesting cannula with a diameter 3.2 × 1.4-mm hole and a 1-mm hole, respectively. The 10-mL syringes full of fat were then put into a centrifuge for 3 minutes (LP) and 1 minute (SP) at 3000 revolutions/min. Fat was then transferred to a 1-mL syringe with Luer-Lock adapters and a blunt cannula of 0.9-mm diameter. The force needed to push the fat out of the cannula was measured with a force gauge. The force was measured within the different groups according to particle size of the fat, temperature of the fat, and released amount of fat. The force needed to push the SP fat out of the cannula into the air with minimal amount (MA) (0.01-0.02 mL) injected at room temperature (25 °C) (1.75 ± 0.82 N) was significantly greater (P = 0.000 [t test]) than at body temperature (BT, 33 °C) (1.27 ± 0.38 N). At BT, the force needed to push the SP fat into subcutaneous pig tissue (2.30 ± 1.46 N) was significantly lesser (P = 0.000 [t test]) than LP fat (6.54 ± 2.39 N). At BT, the force needed to push the MA of SP fat into pig subcutaneous tissue (1.38 ± 0.26 N) was significantly lesser (P = 0.000 [t test]) than the force needed to push the usual amount (0.03-0.04 mL) of SP fat (3.83 ± 1.78 N). The force needed to push the fat into human lower eyelids at room temperature (4.06 ± 2.26 N) was significantly greater (P = 0.000 [t test]) than at BT (2.11 ± 0.96 N). At BT, the force needed to inject an MA of SP fat into human lower eyelids (1.55 ± 0.83 N) was significantly lesser (P = 0.000 [t test]) than the force needed to inject a usual amount of fat (2.78 ± 1.03 N). We suggest injections of the SP (1-mm hole diameter harvesting cannula) fat with MAs (0.01-0.02 mL) by means of fragmented incremental injections stored at BT (33°C) to reduce the injection pressure.

Supporting strength of septal extension grafts.

The aim of this study was to measure the supporting strength of septal extension grafts according to the linking methods. Swine scapular cartilages were harvested, and these were cut into pieces measuring 10 × 20 × 2 mm. For the overlapping type, a 4-mm length of each cartilage was overlapped and fixed using 2 interrupted sutures. For the interdigitating type, 2 parallel incisions (5 mm in length) were made 3 mm apart on each cartilage. The tongue of 1 cartilage was slipped into the groove of the other cartilage, and 2 fixation sutures were made. One end of the connected cartilage was gripped with a vise, and a 3-0 silk was passed through the other tip. The degree of sagging of the connected cartilage was measured using micrometers according to the power of a force gauge. The contralateral bending force, the ipsilateral bending force, and the shearing force were measured. In each group, 8 assembled extension grafts were measured and then analyzed with independent sample t-tests.For the contralateral bending force, there was no significant difference between the overlapping type and the interdigitating type (P = 0.494 for 5-mm bending and 0.834 for 10-mm bending). For the ipsilateral bending force, there was also no significant difference between the overlapping type and the interdigitating type (P = 0.247 for 5-mm bending and 0.529 for 10-mm bending). For the shearing force, there was no significant difference between the overlapping type and the interdigitating type (P = 0.495 for 5-mm bending and 0.462 for 10-mm bending). When performing a septal extension graft, the overlapping type is thought to be technically easier than the interdigitating type. Because the bending force and the shearing force are similar for the 2 methods, the easier overlapping type extension graft might be preferred when performing nasal tip surgery.

Size of the superior palpebral involuntary muscle (Müller muscle).

The aim of this study was to elucidate the width and length of the superior palpebral muscle by using anti-α-smooth muscle actin antibody. Ten orbits of 5 adult Korean cadavers were used. Eyelids were cut in vertical planes through midpupilliary, medial limbus, and lateral limbus and in horizontal planes at the anterior border of the superior transverse ligament and 2 mm proximal to the upper tarsal border. Superior palpebral muscle was localized using mouse monoclonal anti-α-smooth muscle actin and counterstained with light green for collagen. In enlarged pictures of sections, widths, lengths, and thicknesses of the superior palpebral involuntary muscle were measured with a curved scale and were analyzed. The levator palpebrae superioris muscle was divided into superficial and deep parts below the superior transverse ligament. The levator aponeurosis originated from the superficial part and the superior palpebral muscle originated from the deep part of the levator palpebrae superioris muscle. The aponeurosis was inserted into the upper border of tarsus. The superior palpebral muscle fibers arose 2.71 ± 0.64 mm posterior to the anterior border of the superior transverse ligament. The superior palpebral muscle was trapezoidal. The lengths of its sides were 15.58 ± 1.82 and 22.30 ± 5.25 mm, and its height was 13.70 ± 2.74 mm. The levator aponeurosis covered the superior palpebral muscle anteriorly. The width of the levator aponeurosis was approximately 4 mm wider than the superior palpebral muscle. The thicknesses of the superior palpebral muscle were 0.14 ± 0.13 mm at the anterior border of the superior transverse ligament, 0.45 ± 0.11 mm at the superior fornix level, and 0.10 ± 0.03 mm at the upper border of the tarsal plate. One vascular layer was between the levator aponeurosis and the superior palpebral muscle (upper vascular layer), and the other was between the superior palpebral muscle and the conjunctiva (lower vascular layer). At the superior fornix level, thickness of the upper and lower vascular layers was 0.28 ± 0.06 and 0.38 ± 0.21 mm, respectively. The result of our study might contribute to corrective blepharoptosis surgery.

Microscopic relation of palatopharyngeus with levator veli palatini and superior constrictor.

The aim of this study was to elucidate microscopic relation between the levator veli palatini, palatopharyngeus (PP), and superior constrictor (SC) muscle in transverse, parasagittal, and coronal sections.In 10 Korean adult cadavers, the entire soft palate was removed, trimmed, and preserved in 10% neutral buffered formalin. Specimens were embedded in paraffin and sectioned at a thickness of 10 mum. Blocks were cut the course of levator veli palatini. Also, transverse, parasagittal, and coronal section were made, stained using Masson trichrome, and observed under light microscope.Levator veli palatini was inserted between mucous gland anteriorly and musculus uvulae posteriorly in the midline of the soft palate, where they interdigitated with those in the contralateral side. Palatopharyngeus originated from the palatine aponeurosis and posterior mucosa of the soft palate. Most of the fibers of the PP did not cross the midline in their origin; however, some fibers interdigitated across the midline. As PP went downward and crossed the levator, it divided into anterior fasciculus and posterior fasciculus. Anterior fasciculus was thick and went downward along the anterolateral side of the levator. Posterior fasciculus was thin and widely spread along the posteromedial side of levator. Below the levator, 2 fasciculi united and were inserted to the medial side of SC. There were close attachment between the PP and SC.A detailed understanding of the microscopic relationship between the levator veli palatini, PP, and SC muscle is desirable for performing pharyngeal flap surgeries.

The effect of hydrolyzed gardeniae fructus extract hydrogel on the treatment of ecchymoses in a rat model.

BACKGROUND: Gardeniae fructus (GF) has been used in traditional medicine for the treatment of inflammatory disease. OBJECTIVE: To evaluate the therapeutic effect of GF gel on the resolution of ecchymoses in rats. METHODS AND MATERIALS: Fifty hind limbs (in 25 Sprague-Dawley rats) were evaluated. The ecchymoses were produced by dropping a 100-g weight from a height of 20 cm on the posterior side of the hind limbs 25 times. Then, 0.5 g of hydrolyzed GF extracted gel was applied to the right hind limbs and 0.5 g of gel without GF extract powder was applied to the left hind limbs. The area of the ecchymosis was measured, and histological analysis was performed. RESULTS: The area affected by the ecchymosis after 5 days was 15% in the control group and 2% in the GF gel group (p=.002). The mean duration for the ecchymosis was 5.8 days in the control group and 4.5 days in the GF gel group. The extravasated red blood cells and inflammation were less prominent in the GF gel group than in the control group. CONCLUSION: The results of this study showed that hydrolyzed gel of GF extract, containing genipin, was effective for the treatment of ecchymoses in a rat model.

Anatomic study of the lateral palpebral raphe and lateral palpebral ligament.

The aim of this study is to elucidate anatomic detail of the lateral canthal area relating to lateral canthoplasty. Thirty-three hemifaces of 22 Korean adult fresh cadavers were used. Thirty-one specimens were used for tension measurement and 2 for histologic study. There were 3 components of the lateral canthal area under the skin; lateral palpebral raphe (LPR), superficial lateral palpebral ligament (SLPL), and deep lateral palpebral ligament (DLPL). Lateral ends of superior and inferior orbicularis oculi muscles interlaced at the lateral commissure and formed LPR. SLPL extended from the lateral ends of tarsal plate to the periosteum of lateral orbital rim. Its transverse length was 9.4 +/- 2.6 mm and vertical width was 3.6 +/- 1.3 mm. DLPL extended from the lateral ends of tarsal plate deep to the origin of SLPL to Whitnall's tubercle on zygomatic bone inside the orbital margin. It is located deeper than SLPL. Its transverse length was 7.3 +/- 1.6 mm and its vertical width was 9.0 +/- 1.6 mm. Tensile strength of DLPL was 73.2 +/- 26.8 N and stronger significantly than SLPL (30.0 +/- 17.3 N). Tensile strength of LPR was 12.2 +/- 8.0 N and weaker significantly than SLPL and DLPL. A detailed understanding of 3 layered structures (LPR, SLPL, and DLPL) at lateral canthal area is conducive to performing lateral canthoplasty.

Cutaneous innervation of lower eyelid.

The loss of skin sensation or numbness after lower blepharoplasty is not uncommon. The aim of this study is to elucidate the infraorbital nerve (ION) and zygomaticofacial nerve (ZFN) in detail. Twenty-one hemifaces of 14 fresh Korean adult cadavers were dissected. Infraorbital nerve and ZFN came out of infraorbital foramen and zygomaticofacial foramen. They ran along superficial to the periosteum within and beneath the epimysium of the orbicularis oculi muscle and then through orbicularis oculi muscle perpendicularly and distributed to the skin. The distal branch approached to the lower border of the tarsal plate. Most terminal branches (93.8%) of ION were distributed medial to the lateral canthus. Only a few branches (6.2%) were lateral to the lateral canthus. Most (99.4%) terminal branches of ZFN were distributed lateral to the lateral canthus. Very few (0.6%) branches were medial to the lateral canthus. We conclude that the skin-muscle flap infringes less than the skin flap on the terminal branches of ION and ZFN in exposure of the orbital floor as well as in lower blepharoplasty.

Posterior cutaneous nerve of the thigh relating to the restoration of the gluteal fold.

The aim of this study was to elucidate the anatomic relationship between the posterior cutaneous nerve of the thigh (PCNT) and the gluteal fold.A total of 20 amputated thighs from 10 fresh Korean cadavers were used in this study (10 men; age range, 52-76 years). The PCNT was located at an average distance of 13.1 +/- 1.7 cm (medial range, 10.5-16.0 cm) medial to the gluteal fold. The majority of the PCNT travels along the middle 1/3 of the thigh at the level of the gluteal fold (medial 3/10 to 6/10; average, 42.1% +/- 8.7%; range, 23.8%-59.2%). The majority (85%) of the sites of emergence of the perineal branches were located within a rectangular region that covered the medial 1/4 to 1/2 of the thigh on the x axis and the proximal 1/12 to 1/4 of the thigh on the y axis. Most (78%) of the sites of emergence of the inferior cluneal nerve were located within 2 semicircular regions, an upper semicircle and a lower semicircle. The upper semicircle was 3 cm in diameter, and its center was located in the medial 2/5 of the thigh on the x axis. The lower semicircle was 2.5 cm in diameter, and its center was located at the midpoint of the thigh on the x axis. The majority (90%) of the main branches of the PCNT were located within a rectangular region, the base of which extended from the medial 1/3 to 2/3 of the thigh on the x axis and the height of which was in the proximal 1/10 to 2/5 of the thigh on the y axis. Our study describes the characterization of the site and reach of the PCNT in the thigh. It is imperative to know the exact location of the PCNT to avoid causing injury to the nerve during buttock lift.

Could skin retraction incision minimize nerve injury over the iliac crest?

The aim of this study is to elucidate the nerve passage over the iliac crest shifted by skin retraction in harvesting iliac bone graft. A total of 44 iliac crests obtained of 22 nonembalmed Korean fresh cadavers were dissected (six males and 16 females; age range, 57-91 years). In A group (22) of "reposed skin," a skin incision was made from the anterior superior iliac spine (ASIS) to the highest level of iliac crest (HLIC). In B group (22) of "medial retraction," skin was tugged medially 1.5 cm and an incision was made from ASIS to HLIC. In A group, the nerve branches were injured in 19 (86.4%) and 15 (68.2%) in B group. Most injured nerves crossed over the iliac crest and at the posterior half site of ASIS to HLIC. The involved nerves were the subcostal nerve, iliohypogastric nerve, and ilioinguinal nerve. Subcostal nerve was less inflicted with injury in B group (one branch, 4.5%) than A group (four branches, 18.2%). P value is 0.151. Iliohypogastric nerve was significantly least injured in B group (three branches, 13.6%) compared with A group (10 branches, 45.5%). P value is 0.022. An injuring rate of ilioinguinal nerve was almost the same between A group (13 branches, 59.1%) and B group (14 branches, 63.61%). P value is 0.760. In the procedure of harvesting iliac bone graft, it is suggested to make an incision on the skin retracted medially and on the anterior half site of ASIS to HLIC to avert an injury of superficial sensory nerves.

Location of the zygomaticofacial foramen related to malar reduction.

The aim of this study was to elucidate zygomatico-facial foramen (ZFF) relating to malar reduction surgery. Fifty-five dry skulls of adult Koreans were studied. A total of 100 (90.9%) ZFF were observed in 110 skulls. ZFF was variably more than one: one in 56 specimens (50.9%), 2 in 33 (30%), 3 in 10 (9%), and 4 in one (0.9%). ZFF was located 7.3 mm lateral and 3.7 mm inferior to P point, which was defined as crossing a line along the upper border of the zygomatic arch and a vertical line on the lateral orbital rim. The distance from the zygomatic suture to ZFF was 24.4 mm on average. ZFF was located 7.61 mm from the closest orbital rim. ZFF was located 13.0 mm from the nearest zygomatic angle (the junction of the zygomatic arch and lateral orbital rim). Most ZFF were within an ellipse of 15 mm in the major axis and 5 mm in the minor axis. The ellipse was 5 mm from P point. Our data suggest the osteotomy line in malar reduction should be placed at least 10 mm lateral to the lateral orbital rim.