• Archives of Plastic Surgery
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• v.42 no.4
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• pp.424-430
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• 2015

Background Reconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS) is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes. Methods We divided 74 patients who underwent the reconstruction of the orbital floor and medial wall concomitantly into a comminuted IMS group (41 patients) and non-comminuted IMS group (33 patients). In the comminuted IMS group, we first reconstructed the floor stably and then the medial wall by using separate implant pieces. In the non-comminuted IMS group, we reconstructed the floor and the medial wall with a single large implant. Results In the follow-up of 6 to 65 months, most patients with diplopia improved in the first-week except one, who eventually improved at 1 year. All patients with an EOM limitation improved during the first month of follow-up. Enophthalmos (displacement, 2 mm) was observed in two patients. The orbit volume measured on the CT scans was statistically significantly restored in both groups. No complications related to the surgery were observed. Conclusions We recommend the reconstruction of orbit walls in the comminuted IMS group by using the following surgical strategy: usage of multiple pieces of rigid implants instead of one large implant, sequential repair first of the floor and then of the medial wall, and a focus on the reconstruction of key areas. Our strategy of step-by-step reconstruction has the benefits of easy repair, less surgical trauma, and minimal stress to the surgeon.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.39.1-39.6
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• 2016

Background: Temporomandibular joint (TMJ) ankylosis in children often leads to facial deformity, functional deficit, and negative influence of the psychosocial development, which worsens with growth. The treatment of TMJ ankylosis in the pediatric patient is much more challenging than in adults because of a high incidence of recurrence and unfavorable growth of the mandible. Case report: This is a case report describing sequential management of the left TMJ ankylosis resulted from trauma in early childhood. The multiple surgeries including a costochondral graft and gap arthroplasty using interpositional silicone block were performed, but re-ankylosis of the TMJ occurred after surgery. Alloplastic TMJ prosthesis was conducted to prevent another ankylosis, and signs or symptoms of re-ankylosis were not found. Additional reconstruction surgery was performed to compensate mandibular growth after confirming growth completion. During the first 3 years of long-term follow-up, satisfactory functional and esthetic results were observed. Conclusions: This is to review the sequential management for the recurrent TMJ ankylosis in a growing child. Even though proper healing was expected after reconstruction of the left TMJ with costal cartilage graft, additional surgical interventions, including interpositional arthroplasty, were performed due to re-ankylosis of the affected site. In this case, alloplastic prosthesis could be an option to prevent TMJ re-ankylosis for growing pediatric patients with TMJ ankylosis in the beginning.

• Korean Journal of Health Education and Promotion
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• v.18 no.2
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• pp.141-156
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• 2001

This study was performed to identify the occupational diseases in the dental technicians working in Korea, and to elucidate the main related affecting factors for the occurrence of the occupational diseases. The research was carried out using a mail questionnaire and data collection was done for two months from April 15, 2000. The questionnaires were delivered to 1000 dental technicians working at 250 dental laboratories which were chosen among the total 1330 dental laboratories in south Korea. And 763 questionnaires were collected, then 739 questionnaires were used for a logistic and a multiple regression analyses. The results obtained in this study are summarized as follows: 1. The occupational diseases in the dental technicians included pneumoconiosis, chronic bronchitis, asthma, pneumonia, hyposmia, allergic dermatitis, eczema, contagious dermatitis, central nervous disorder, dysfunction of finger, vertebral disorder, dysfunction of interphalangeal joint, ophthalmitis, auditory dysfunction, otitismedia, optic trauma, and bum. 2. The main related affecting factors for the occurrence of the occupational diseases in the dental technicians were elucidated as follows: On the ccurrence of chronic bronchitis, vibration of equipment and job career were affected positively. On the ccurrence of asthma, job career and career on current working part were affected positively, but exhaust ventilation, work hour were affected negatively. On the occurrence of eczema, career on current working part and vibration of equipment were affected positively, but personal protective equipment, local exhaust ventilation, isolation of gas source were affected negatively. And eczema was occurred more in methyl methacrylate work than in any other work part. On the occurrence of finger dysfunction, vibration of equipment and noise of work place were affected positively. But personal protective equipment, local exhaust ventilation, isolation of dust and gas source were affected negatively. But finger dysfunction was occurred more in metal polishing than in any other work part. On the occurrence of auditory dysfunction, noise of work place were affected negatively. The results obtained in this study can give a valuable information for a prevention of the occupational diseases in the dental technicians working in Korea, and for keeping them in healthy. This study also can be helpful for a researcher who is aiming at a identification of occupational diseases and a elucidation of related affecting factors in a similar occupation.

• Korean Journal of Community Nutrition
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• v.11 no.1
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• pp.124-132
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• 2006

The aim of this study is to evaluate the clinical outcome. Between January 1,2002 to September 30, 2002, we prospectively and retrospectively recruited III hospitalized patients who received Enteral Nutrition (EN group n = 52) and Total Parenteral Nutrition (TPNgroup n = 59) for more than seven days. The factors of clinical outcomes are costs, incidences of infection, lengths of hospital stay, and changes in weight. The characteristics of patients were investigated, which included nutritional status, disease severity CAP ACHE III score) and hypermetabolic severity Chypermetabolic score). Hypermeta-bolic scores were determined by high fever (> $38^{\circ}C$), rapid breathing (> 30 breaths/min) , rapid pulse rate (> 100 beats/min), leukocytosis (WBC > 12000 $mm^{3}$), leukocytopenia (WBC > 3000 $mm^{3}$), status of infection, inflammatory bowel disease, surgery and trauma. There was a positive correlation between hypermetabolic score and length of hospital stay (ICU), medical cost, weight loss, antibiotics adjusted by age while APACHEIII score did not show correlation to clinical outcome. Medical cost was higher by $18.2\%$ in the TPN group than the EN group. In conclusion, there was a strong negative correlation between the clinical outcome (cost, incidence of infection, hospital stay) and hypermetabolic score. Higher metabolic stress caused more malnutrition and complications. For nutritional management of patients with malnutrition, multiple factors, including nutritional assessment, and evaluation of hypermetabolic severity are needed to provide nutritional support for critically ill patients.

• Journal of Trauma and Injury
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• v.25 no.2
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• pp.37-43
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• 2012

Purpose: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. Methods: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. Results: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. Conclusion: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.178-181
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• 2010

Purpose: Retronychia is the embedding of the nail into proximal nail fold. Retronychia starts with disruption of the longitudinal growth of the nail. With the growth of a new nail, the old one is pushed upwards and backwards. This leads to embedding of the top nail into the ventral aspect of the proximal nail fold and results with chronic paronychia. We present a case of retronychia that was rarely reported in the literature. Methods: A 46-year old female presented with a 3-month history of painful right first, 2nd, 3rd toenail changes. Although she was initially treated with broad spectrum antibiotics, she did not response to therapy. Later, she presented to our department because of progressively worsening pain that impaired her walking. Physical examination revealed with proximal nail fold erythema, painful swelling, yellowish nail discoloration, and distal onycholysis. Bacterial and fungus culture showed no organism. Treatment was surgical nail avulsion under local anesthesia. Results: The postoperative course was uneventful. 10 months later, the patient had a normal growing nail and was free of symptoms. Conclusion: We report a case of retronychia on toenail. Retronychia is a proximal nail plate ingrowth into the proximal nail fold which is associated with multiple generations of nail plate misaligned beneath the proximal nail. Management consisted of simple avulsion of superimposed nail. Retronychia is suspected with a persistent paronychia, particularly in the setting of trauma. Avulsion of the top nail confirms the diagnosis and may be curative if the underlying nail appears healthy.

• The Korean Journal of Nuclear Medicine
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• v.27 no.2
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• pp.309-314
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• 1993

We report a case of 33-year-old man with a transient splenic uptake who had traumatic multiple rib fractures and hernoperitoneum combined with underlying liver cirrhosis, liver cirrhosis with liver bed laceration and splenomegaly without any other demonstrable splenic lesion due to traffic accident was found by abdominal ultrasound and surgery. Incidentally, $^{99m}Tc$-MDP Bone scan showed whole prominent splenic uptake, spleen was also visible on $^{99m}Tc$ Tin colloid liver scan. We suggest the splenic uptake of the radionuclide temporary splenic infarct to the transient total splenic infarction or unknown traumatic effect.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.1
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• pp.75-79
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• 2008

Blunt trauma, drugs, infection, congenital anomalies of the pancreaticobiliary system, and multisystem diseases are the main causes of acute pancreatitis in children. Various viruses can cause acute pancreatitis, but varicella-induced pancreatitis is unusual and generally observed in adults or immunocompromised patients. We report a rare case of acute pancreatitis associated with varicella-zoster virus infection in a 6-year-old immunocompetent girl. The patient initially presented complaining of severe abdominal pain and repetitive vomiting. The patient had multiple cutaneous crusts that has been caused by preceding varicella infection and had elevated values of serum amylase and lipase. Abdominal ultrasonography demonstrated swelling of the pancreas and pancreatic duct dilatation, findings which were compatible with acute pancreatitis. The patient's clinical and laboratory abnormalities were completely normalized through conservative treatment consisting of fasting, total parenteral nutrition, and analgesic therapy.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.531-535
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• 2006

Purpose: To report our experience of retro-angular flap for reconstruction of the midface defect. The midface, including nose, lower eyelid, and intercanthal area, is the very prominent area of face. Also midface is more vulnerable to trauma and skin cancer and defect of mid face of highly perceptible. Reconstruction of mid face is difficult because of complexity of anatomy and functions. Following factors should be considered in reconstructive prcedure of midface. First, multiple procedure may need for complete the reconstruction of mid face defect. Second, secondary reconstructive surgeries such as flap rotation or skin graft may need for donor site morbidity. Third, the color, texture and thickness of the skin used are not always complacency. Methods: 8 cases of the midface defects (3 cases of lower eyelid, 1 case of intercanthal area, and 4 cases of nose) from skin cancer were reconstructed with retroangular flap from March 2004 to August 2005. Results: Satisfactory result were obtained in color, texture and donor site scar. There was no major complication such as wound disruption, hematoma, and atrophy of flap. But partial necrosis of flap and bulkiness were observed one case in each. Retroangular flap is simple procedure that can be preceded in one stage under local anesthesia closing primary wound closure. It will leave less visible donor scar, acceptable color, texture and thickness of the skin. Conclusions: The retro-angular flap could be suggested as a safe and effective method for midface reconstruction.

• Advances in biomechanics and applications
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• v.1 no.3
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• pp.169-185
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• 2014

Computational multibody models of the elbow can provide a versatile tool to study joint mechanics, cartilage loading, ligament function and the effects of joint trauma and orthopaedic repair. An efficiently developed computational model can assist surgeons and other investigators in the design and evaluation of treatments for elbow injuries, and contribute to improvements in patient care. The purpose of this study was to develop an anatomically correct elbow joint model and validate the model against experimental data. The elbow model was constrained by multiple bundles of non-linear ligaments, three-dimensional deformable contacts between articulating geometries, and applied external loads. The developed anatomical computational models of the joint can then be incorporated into neuro-musculoskeletal models within a multibody framework. In the approach presented here, volume images of two cadaver elbows were generated by computed tomography (CT) and one elbow by magnetic resonance imaging (MRI) to construct the three-dimensional bone geometries for the model. The ligaments and triceps tendon were represented with non-linear spring-damper elements as a function of stiffness, ligament length and ligament zero-load length. Articular cartilage was represented as uniform thickness solids that allowed prediction of compliant contact forces. As a final step, the subject specific model was validated by comparing predicted kinematics and triceps tendon forces to experimentally obtained data of the identically loaded cadaver elbow. The maximum root mean square (RMS) error between the predicted and measured kinematics during the complete testing cycle was 4.9 mm medial-lateral translational of the radius relative to the humerus (for Specimen 2 in this study) and 5.30 internal-external rotation of the radius relative to the humerus (for Specimen 3 in this study). The maximum RMS error for triceps tendon force was 7.6 N (for Specimen 3).