The effect of the YK lens in keratoconus.

PURPOSE: To report the clinical results of the use of the YK contact lens (Lucid Co., Seoul, Korea) for keratoconus. METHODS: One hundred and twenty nine keratoconic eyes were fitted with a YK lens which has one base curve and three peripheral curves. A light feather touch fluorescein pattern was obtained based on topographic indices. Visual acuity, comfort, mean wearing time, and ocular tissue changes were evaluated. Mean follow up was 17.5 +/- 13.8 months (range 6-75). RESULTS: One hundred and twenty six (97.6%) eyes tolerated the contact lenses. A total of 94.5% of the eyes achieved a visual acuity of 20/40 or better (average 0.79 +/- 0.21), and flatter base curve radius (BCR) was related to better visual acuity. One hundred and seventeen (90.7%) eyes reported that the lenses were comfortable. Mean wearing time was 12.1 h per day (range 4-18). Changes in keratometric values were not significant between baseline and final follow-up visit. CONCLUSIONS: The YK lens can provide successful visual outcome, with comfort, and no significant influence on the progression of keratoconus.

Analysis of the postoperative outcome in 405 cases of orbital fracture using 2 synthetic orbital implants.

The purpose of this study was to analyze the postoperative complications according to the location (floor/medial wall/floor and medial wall) of the orbital fracture of 405 patients during the past 10 years and to investigate the possible alterative data in postoperative outcome in change with the application of 2 synthetic orbital implants: porous polyethylene (Medpor) and hydroxyapatite (Biocoral). The medical records of 405 patients were reviewed especially for enophthalmos, diplopia, sensory disturbance in the area of distribution of the infraorbital nerve, and postoperative complications originated from the implanted material itself, from March 1993 to July 2003. Of the 405 patients, 214 patients were operated with porous polyethylene and 191 patients with hydroxyapatite. The complication rate of the porous polyethylene group was 5.6%, which was not statistically different from that of the hydroxyapatite group (9.4%). Also by the location of fracture, the complication rate of both groups was similar statistically. In the comparative category, enophthalmos was more frequent statistically in patients treated with hydroxyapatite than those treated with porous polyethylene, and no other significant differences were in postoperative outcomes between the both groups. The information provided in this report should aid in using porous polyethylene or hydroxyapatite for reconstruction of the orbital fracture and in accomplishing better postoperative outcome.

Characterization of breast lesion using double phase Tc-99m Tetrofosmin scintimammography: comparison of visual and quantitative analyses.

UNLABELLED: To compare the diagnostic performances of visual and quantitative indices of double phase Tc-99m Tetrofosmin scintimammography (TF-SMM) for the detection of breast cancer. METHODS: Double phase TF-SMM (early, 10 min; delayed, 3h) were performed after injection of 925 MBq of Tc-99m Tetrofosmin in 75 highly suspected breast cancer patients (malignant: 49, benign: 26). For visual analysis, five scoring method was used. For quantitative analysis, early, delayed lesions to non-lesion ratios (L/Ns) and washout rate (%, WR) were calculated. Receiver operating characteristic curve (ROC) analyses were performed to determine the optimal visual grade, to calculate cut-off values of quantitative indices, and to compare visual and quantitative diagnostic performances. RESULTS: When over grade 3 of visual grade was used as cut-off value in the defection of primary breast cancer, the sensitivity and specificity were 75.5 and 80.8%, respectively. The positive and negative predictive values were 88.1 and 63.6%, respectively. The area under curve was 0.824 (95% CI, 0.719-0.902) and standard error (S.E.) was 0.047. The optimal L/N ratios were 3.13 for early and 2.56 for delayed image. When early L/N 3.13 was used as cut-off point, the sensitivity and specificity of TF-SMM were 61.2 and 96.2%, respectively. The positive and negative predictive values were 96.8 and 56.8%, respectively. The AUC was 0.809 (95% CI, 0.702-0.890) and S.E. was 0.049. When delayed L/N 2.56 was used as cut-off value, the sensitivity and specificity were 46.9 and 96.2%, respectively. The positive and negative predictive values were 95.8 and 49%, respectively. The AUC was 0.741 (95% CI, 0.627-0.835) and S.E. was 0.057. No statistical differences between visual assessment and quantitative analysis of early image (difference between area, 0.015; S.E., 0.044; 95% CI, -0.072 to 0.102; p = 0.736) and delayed image (difference between area, 0.083; S.E., 0.054; 95% CI, -0.023 to 0.060; p = 0.189) was noted. However, early L/N was superior to delayed L/N ratio for the detection of breast cancer (difference between area, 0.068; S.E., 0.033; 95% CI, 0.004-0.132; p = 0.038). CONCLUSION: In conclusion, TF-SMM showed a favorable diagnostic accuracy in differentiating benign from malignant breast lesions. The optimal visual interpretation grades for the detection of primary breast cancer of double phase TF-SMM were grade 4 and 5. The optimal quantitative indices for the detection of breast cancer were 3.12 for early L/N and 2.56 for delayed L/N. Visual and quantitative analyses showed similar results. However, early L/N was superior to delayed one for the detection of breast cancer. Therefore, the delayed image should not be routinely performed for the purpose of primary breast cancer detection. These findings deserve further investigation on a larger number of patients to be performed to allow a better validation of the differentiation malignant from benign breast lesions using double phase TF-SMM.

A simple and quantitative method for three-dimensional measurement of normal smiles.

Smile reconstruction is one of the most challenging fields in plastic surgery. An understanding of the normal smile is essential in planning surgery for facial paralysis. The purpose of this study was to suggest a simple and quantitative method for the 3-dimensional analysis of smiles and to establish a basis for smile reconstruction in facial paralysis patients. The smiles of 50 volunteers (25 men and 25 women) were observed using a 6-mm digital video camera. Each subject had 10 points marked on the lips and nasolabial creases. Video editing programs were used to capture images of the resting and maximum smiles. The opacity of the image of maximum smile was adjusted and was merged with the resting image so that the migration of the points could be observed in 1 image. The migration distance (in millimeters) and the direction (in degrees) between each point were measured in frontal and both lateral views, and thus 3-dimensional vectors (x, y, z scalars) were obtained. The scalar values were converted to the values of a spherical coordinate system (distance, angle alpha and beta). Our work may offer a simple and quantitative method for measuring the smile and accurate guidance for reconstructive surgery.

A report of 12 cases of basal cell carcinoma arising in lesions following laser therapy.

Since the latter half of the 1990s, laser treatment has become a common practice in Korea. A group of patients diagnosed as having basal cell carcinoma (BCC) also had a history of prior laser therapy performed on undiagnosed cutaneous lesions. Clinical and histologic evaluations of these cases were performed retrospectively. Among the 138 patients who were diagnosed with BCC from 1997 to 2001, 12 lesions (8.7%, 3 males and 9 females) developed following previous laser treatment to remove undiagnosed lesions. The mean age of the patients was 55.6 years, which was younger than that of the general Korean population (62.7 years), and their noses were the most common site of lesion development. The lesions had disappeared grossly after laser therapy for 6 patients, but for the other 6 patients, their lesions had persisted or grown. The interval between the time of laser therapy and diagnosis of BCC ranged from 1 month to 3 years. The average interval was 18 months. Histologically, aggressive forms were more common in these cases as compared with the usual patterns of BCCs. Although we do not think that laser therapy causes the development of BCC directly, laser therapy does not seem to be adequate for undiagnosed lesions. And our conclusion is that the cutaneous lesions should be biopsied and thoroughly diagnosed and managed prior to laser therapy.

Treatment of atrophies secondary to trilinear scleroderma en coup de sabre by autologous tissue cocktail injection.

BACKGROUND: The atrophies are left after regression of linear scleroderma "en coup de sabre." They are often irreversible and disfiguring. Several surgical techniques have been attempted to correct atrophies secondary to linear scleroderma en coup de sabre. However, the result often has proved unsatisfactory. METHODS: A patient with atrophies secondary to trilinear scleroderma en coup de sabre was treated with autologous tissue cocktail injection. RESULTS: Autologous tissue cocktail injection provided excellent cosmetic results for the treatment of atrophies secondary to trilinear scleroderma en coup de sabre. There were no complications at the donor and recipient site in the postoperative period. CONCLUSION: Autologous tissue cocktail injection appears to be a useful method for the correction of depressed atrophy of linear scleroderma en coup de sabre.