ObjectiveTo evaluate the expression of heat shock genes and acute phase genes and to examine the hepatic ultrastracture under the stress of intermittent Pringle manoeuvre. MethodsRT-PCR was used to detect the expression of HSP70A, HSC70, TNF-? and IL-6,and electronic microscopy examination was taken to document the ultrastructural change in patients with hepatocellular carcinoma, with or without, Pringle manoeuvre, during the operations. ResultsHeat shock gene family-HSP70A and HSC70, which is related to intracellular repair and cell protection, was on higer expression after liver transection in Pringle manoenvre group than that of control group. Normal ultrastructure were also found in liver parenchymal cells and nonparenchymal cells in Pringle manoeuvre group after liver resection. ConclusionIntermittent Pringle manoeuvre induced relatively higher expression of heat shock genes, which are related to intracellular homestasis, and was consistent with the well maintenance of liver ultrastructure.

Adenoid cystic carcinoma of the major salivary gland is a relatively rare tumor which is well known for its high local recurrence rate and frequent distant metastasis. Metastasis of this tumor to kidney has not been reported previously to our knowledge. We report two cases of renal metastasis from adenoid cystic carcinoma of the salivary gland.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Kidney ; Neoplasm Metastasis* ; Recurrence ; Salivary Glands*

BACKGROUND: It has been suggested that diabetic patients are under high oxidative stress and plasma MDA concentration is a reliable marker for oxidative stress. However, some studies showed that plasma MDA is not a good marker for oxidative stress. Reeently, the total radical-trapping antioxidant parameter (TRAPc) has been proposed as a marker for the overall antioxidant property of plasma samples. Therefore, in this study, we tried to evaluate whether MDA and TRAPc are reliable markers of the oxidative stress-antioxidant system or not. METHODS: The plasma samples from 67 type 2 diabetic patients and 31 normal subjects were collected. The plasma MDA, protein-bound SH groups, uric acid and vitamin C were determined by fluorophotometry or spectrophotometry. Plasma vitamin E concentration was analyzed by HPLC. Calculated TRAP (TRAPc) were determined by the proposed calculation methods. RESULTS: 1. Diabetic patients had significantly lower TRAPc, compared with normal subjects. 2. SH groups, uric acid, vitamin C and vitamin E were not different between the two groups. 3. MDA and MDA/TG were significantly higher in diabetic subjects. CONCLUSION: From the results of this study, TRAPc seems to be a reliable parameter of overall plasma antioxidant system and the plasma MDA may be used as a marker of oxidative stress, but further long-term logitudinal studies are needed.
Ascorbic Acid ; Chromatography, High Pressure Liquid ; Fluorophotometry ; Humans ; Oxidative Stress ; Plasma ; Spectrophotometry ; Uric Acid ; Vitamin E ; Vitamins

The authors described a case of male schizophrenia who developed myoclonic jerk repeatedly and one episode of convulsive seizure during the treatment of clozapine. According to literatures and reported cases, myoclonic jerks induced in a small amount of clozapine may precede and predict the development of a convulsive seizure. Therefore clinicians have to pay attention to the development of a myoclonic jerk during the administration of clozapine. They may decrease the dosage of clozapine step by step at first in the convulsive state, and observe EEG changes of patients frequently.
Clozapine* ; Electroencephalography ; Humans ; Male ; Myoclonus ; Schizophrenia ; Seizures*

Clostridium difficile is an anaerobic, gram-positive bacterium, capable of sporulation when environmental conditions no longer support its growth. The sporulation capacity enables the organism to persist in the environment for extended periods of time. Clostridium difficile is the main pathogen accountable for antibiotic-associated colitis and for 15% to 25% of cases of nosocomial antibiotic-associated diarrhoea. Major risk factors such as increased severity of underlying illness, increased age, prior antimicrobial use and gastric acid suppressors have been identified for Clostridium difficile.

Stasis dermatitis is one of the important skin manifestations of venous stasis. Therefore, the searching for the cause of venous stasis is importrnt. Two cases of stasis dermatitis with inferior vena caval obstruction are reported and possible etiologic factor is discussed. Case I The patient, 38-year-old carpenter, was admitted at Choong Buk Medical Center in April, 1974 with superficial venous engorgement of the lower extremities which had begun to appear two years after severe blunt trauma to both legs in 1962. 5 years prior to admission, abdomial venous engorgement and abdominal fullness developed and was exaggerated gradually. Since 2 years prior to admission, he has been suffered from the recurrent exudative ulcer on the right lower leg The physical examination revealed mild icteric sclera, hepatomegaly, abdominal distension, tortuous venous engorgement on the abdomen, the lateral chest wall and the lower extremities, and edematous scaly brawny pigmentation of the lower legs. Esphagogram showed no esphageal varices. Inferior vena cavogram showed complete obstruction at the level of upper border of 2nd lumbar vertebra and well developed collateral circulation, Findings of skin biopsy on the right lower leg showed moderate acanthosis, increased pigmentation of bosal cell layer in the epidermis, capillary proliferation, diffuse inflammatory cell infiltration with increased fibrosis and hemosiderin granules in the dermis. Case II The patient. 36-year-old farmer, was admitted at Dept. of Dermatology, St. Mary's Hospital, Catholic Medical College in Sept., 1973.The physical examination revealed hepatomegaly, abdominal distension, superficial venous engorgement on the abdomen, the neck and the lower extrcmities, severe edema and pigmentation of the lower legs, and the multiplc. Exudative ulcers on the left lower leg. Liver scanning showed somewhat general enlargement with some mottlings along the margin and relative prominance of the left lobe. Liver biopsy revealed findings of non specific chrcnic hepatitis. Inferior vena cavogram through the left femoral vein showed complete obstruction at the level between 11th and 12th thoracic vertebrae.His peripheral edema and ascites was much subsided after adequate bed rest and the skin lesion improved with scar formation.
Abdomen ; Adult ; Ascites ; Bed Rest ; Biopsy ; Capillaries ; Cicatrix ; Collateral Circulation ; Dermatitis* ; Dermatology ; Dermis ; Edema ; Epidermis ; Femoral Vein ; Fibrinogen ; Fibrosis ; Hemosiderin ; Hepatitis ; Hepatomegaly ; Humans ; Hyperemia ; Leg ; Liver ; Lower Extremity ; Neck ; Physical Examination ; Pigmentation ; Sclera ; Skin ; Skin Manifestations ; Spine ; Thoracic Wall ; Ulcer ; Varicose Veins

No abstract available.
Carcinoma, Squamous Cell* ; Liver*

For the reconstruction of soft tissue defect combined with open fracture in the lower leg, free flap, especially muscle free flap which has abundant blood supply, is considered to be the most suitable method. Sometimes, however, injury to the main vessels in the lower leg makes it impossible to use a principal vessel as a recipient vessel. In such cases, vein graft or end-to-side anastomosis can be employed. To acquire a healthier vessel as a recipient,the authors performed crossleg muscle free flap, using a non-injured healthy vessel of the contralateral leg as a recipient vessel. Controversy still lingers over the angiogenesis of cross-leg muscle free flap and thus safety after flap detachment. There have been some clinical case reports on cross-leg muscle free flap, but flap survival after pedicle detachment has been known to be variable according to different authors. Because of the uncertainty of neovascularization in muscular free flap at the time of flap delay procedure,many surgeons hesitate to use a pure muscle free flap as a delay flap. Eight cases of cross-leg muscular free flap were performed by the authors using the rectus abdominis muscle, latissimus dorsi muscle and a combination of the latissimus dorsi and serratus anterior muscle flap. During the operation, the authors estimated the ratio of poorly vascularized bed in recipient soft tissue defect. Despite the high ratio of non-vascularized bed, there was no flap necrosis after pedicle detachment and ample neovascularization within the muscle was confirmed by post-division angiogran. As well, there was no recurrence of osteomyelitis. Conclusively, enough neovascularization in cross-leg free muscle flap, even placed on a poorly vascularized bed, could be induced through a delayed procedure.
Fractures, Open ; Free Tissue Flaps* ; Leg ; Necrosis ; Osteomyelitis ; Rectus Abdominis ; Recurrence ; Superficial Back Muscles ; Transplants ; Uncertainty ; Veins

No abstract available.
Ovarian Neoplasms*

Reconstruction of soft tissue dejects on the lower leg and foot remains a difficult challenge for surgeons. If the deject was large and complicated by bone defects, an excellent result could be obtained with free tissue transfer. In case of no bony problem, no major infection and relatively small defect, a local flap is more Convenient and economic than free tissue transfer because of its simple, one-stage and reliable operation. The vascularization of the subcutaneous tissue reveals the predominance of the vascular network in this layer with regard to the dermal or fascial plane. The dermal vascular network at the donor site is sufficient to let the skin survive without its underlying subcutaneous vascular support. Distally based adipofascial flaps, nourished by the lower perforator originating from the major vessel as link pattern were. used successfully for reconstruction of the bone and/or tendon exposure of the lower leg and foot in 10 patients. Between February 1992 and December 1995, ten cases underwent this procedure to reconstruct soft tissue defect on the lower leg and foot. The average age of the patients was 50.6 years (range 5 - 73years). Follow-up was from 10 months to 38 months (mean 21 months). The average time of the operation was about 2 hours 18 minutes. The length to width ratio of adipofascial flap was 2.4 - 5.0 : 1 (mean 3.4 : 1). The advantages of this method are easy dissection, short operation, preservation of the major vascular pericles of the lower limb, skin preservation at the donor site, thus preserve the shape of the limb and minimize donor site scar, and versatility (it is supple and can adapt to every surface, and it can be grafted on the deep or the superficial side). In conclusion, this technique is an useful and alternative method for reconstruction of soft tissue defects on the lower leg and foot in selected cases.
Cicatrix ; Extremities ; Follow-Up Studies ; Foot* ; Humans ; Leg* ; Linear Energy Transfer ; Lower Extremity ; Skin ; Subcutaneous Tissue ; Tendons ; Tissue Donors ; Transplants