Microvascular tissue transfers have facilitated primary closure of various complex defects after radical ablation of head and neck cancers. From Oct 1991 to Feb 1992, we used forearm free flap in two patients and delto-pectoral flap in one patient who had preoperative irradiation for pharyngoesophageal reconstruction. The stricture and fistula formation were most troublesome complication in forearm free flap, so we designed as lazy S shape in distal flap margin to prevent circular contraction and longitudinal margin was deepithelialized (5 mm) and sutured double layer to withstand fistular formation and this can be considered useful in place of a free jejuna transfer.
Constriction, Pathologic ; Fistula ; Forearm ; Free Tissue Flaps ; Head ; Humans ; Neck

Though the occurrence of multiple primary malignant tumor is a rare finding but the reported cases of it has increased in recent years. We collected multiple primary cancer of different organ, tissue and the multicentric origin of bilaterally paired organs. This paper reports 6 cases of multiple primary malignant tumors which were experienced at Yeungnam university hospital in Taegu during the past 2 years with review of journals. The results were as follows. 1. The incidence of multiple primary cancer was 0.31% for 2 years (1987-1988). 2. The ratio between male and female was 1:1 and mean age of incidence was 54.1 years. 3. The ratio between synchronous and metachronous (interval more than 6 months) was 1:1. 4. The time interval between first and second cancer was average 2.7 years in metachronous cases. 5. The most frequent involved organ was stomach, breast and colon in order of frequency. 6. The incidence of familial cancer associations was found in one out of 6 cases. 7. The test of DNCB, multitest CMI and ratio of T4 to T8 were performed in 4 cases but there was no definitive evidence of abnormality. We concluded that every effort should be made to discover the presence of synchronous malignancies in the patients who are being treated for a known tumor, and also special care should be given to detect new metachronous lesions is required.
Breast ; Colon ; Daegu ; Dinitrochlorobenzene ; Female ; Humans ; Incidence ; Male ; Neoplasms, Second Primary ; Stomach

Authors evaluated the accuracy of preoperative pelvic CT scan staging and its effects on management in 12 biopsy proved rectal cancer patients. Authors also studied postoperative CT in 5 patients to detect disease recurrence and metastasis. Preoperative CT staging was identical to surgical and/or pathological staging in 9 patients (75%), but it was underestimated in two cases and overestimated in one instance than in surgical stagings. In 7 cases, CT scan did not alter original choice of procedures. However, preoperative CT staging gave definitive informations to change management plans in 5 cases otherwise the treatment would be difficult and inadequate. Postoperative CT showed local recurrence in one and liver metastases in 2 cases. One of them was not detected at exploratory laparotomy.
Biopsy ; Humans ; Laparotomy ; Liver ; Neoplasm Metastasis ; Rectal Neoplasms* ; Recurrence ; Tomography, X-Ray Computed*

PURPOSE: Vascular smooth muscle cells (VSMCs) migration and proliferation are important for neointimal formation after arterial injury. Migration of VSMCs requires degradation of basement membrane and extracelluar matrix surrounding the cell, and there is increasing evidence that VSMCs produce extracelluar matrix-degradating proteinases, such as matrix metalloproteinases (MMPs) after arterial injury. To assess the role of MMPs in VSMCs proliferation, migration and intimal thickening, we measured the expression of MMP-2 and MMP-9 in the balloon-injured rat aorta model. METHOD: Twenty-five male Sprague-Dawley rats weighting of 250~300 gm were underwent aortic intimal denudation with 2F balloon catheter. Aorta was harvested at various time intervals of 1, 3, 5, 7, 21 days and then analyzed the MMP expression used by gelatin zymography. Intimal hyperplasia caused by balloon injury was confirmed by microscopic examination. RESULT: MMP-2 (72 kD) was constitutively expressed in the normal aorta and was not increased substantially after injury. But the expression of 62 kd forms, which is activated form of MMP-2, was significantly increased during the period of 5 through 7 days after injury (P<0.05). The expression of MMP-9 (92 kD) was significantly increased at 1st day after injury and diminished thereafter (P<0.05). CONCLUSION: These results suggest that activated MMP-2 (62 kD) and MMP-9 (92 kD) may play an important role in VSMCs migration and formation of intimal hyperplasia after arterial injury. And the activated form of MMP-2 (62 kD) seems to be involved mainly in degradation of basement membrane and matrix.
Animals ; Aorta* ; Basement Membrane ; Catheters ; Gelatin ; Humans ; Hyperplasia* ; Male ; Matrix Metalloproteinases* ; Muscle, Smooth, Vascular ; Peptide Hydrolases ; Rats* ; Rats, Sprague-Dawley

PURPOSE: Iliac vein compression syndrome (IVCS), first characterized by Cockett and Thomas in 1965, is the development of iliofemoral deep venous thrombosis due to compression of the left common iliac vein against the spine and pelvic brim by the right common iliac artery. Thrombectomy treatment of the underlying compression is essential if significant long-term sequelae are to be avoided. Surgical treatment options include venous reconstruction or venous bypass, but treatment using endovascular techniques have recently been described. This study was conducted to evaluate the usability of endovascular treatment (esp. thrombolysis with stent insertion) in a venous outflow obstruction resulting from IVCS. METHOD: During a 2-year period, 20 patients (17 women, 3 men; mean age, 60 years) presented with clinical and imaging findings consistent with IVCS. All patients presented with leg edema or pain. The mean duration of symptom onset was 6.6+/-4.4 days, ranging from 1 to 15 days. All patients were evaluated using a Duplex scan, computerized tomography and venography. After the ascending venography had been performed, an infusion catheter system was placed, and urokinase infused locally into the thrombus burden. After near complete clot dissolution, the residual left common iliac vein stenosis was treated by means of angioplasty and the placement of a Wallstent. All patients continued to receive oral warfarin. Patients were followed-up by means of clinical visits, and the stent patency was assessed by means of a Duplex scan or computerized tomography. RESULT: The total dose of urokinase used and the duration of infusion were 2.28+/-0.93 million unit, ranging from 1.00 to 5.20 and 46.8+/-14.8 hours, ranging from 14 to 72 hours, respectively. Grade III (complete lysis) thrombolysis was achieved in 17 patients. All 17 patients successfully received a Wallstent. The initial clinical success was 100%, with complete resolution of symptoms in all patients. One patient, with combined ovarian cancer, had a recurrent symptomatic deep vein thrombosis and complete occlusion of the stent due to thrombosis 2 months after treatment. However, no other patients showed evidence of deep vein thrombosis after treatment. The overall patency rate of the stenting at 18 months was 94.1%. There were no deaths, pulmonary embolism, cerebral hemorrhage or major bleeding complications. CONCLUSION: These results suggested that the treatment of iliac vein compression syndrome, using catheter directed thrombolytic therapy and venous stent insertion, was a safe and effective method at the mid term evaluation. These patients will continue to be followed up with screening tests to further define the long-term patency.
Angioplasty ; Catheters ; Cerebral Hemorrhage ; Constriction, Pathologic ; Edema ; Endovascular Procedures ; Female ; Hemorrhage ; Humans ; Iliac Artery ; Iliac Vein* ; Leg ; Male ; Mass Screening ; May-Thurner Syndrome* ; Ovarian Neoplasms ; Phlebography ; Pulmonary Embolism ; Spine ; Stents ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis ; Warfarin

BACKGROUND AND OBJECTIVES: Identification of primary maxillary sinus hypoplasia (PMSH) is important diagnostically and therapeutically. Recently, the clinical significance of associated abnormalities in PMSH has been suggested. The aim of this study is to investigate the incidence of PMSH, their associated abnormalities and relationship of anatomical variations and paranasal sinusitis. MATERIALS AND METHODS: We evaluated radiologic diagnostic criteria of PMSH and analyzed the relationship of the anatomical variations of nasal cavity and paranasal sinuses in paranasal sinus CT scans, retrospectively. We measured the volume estimated ratio (VER) in PMSH cases. RESULTS: The incidence of unilateral and bilateral PMSH were 11 cases (5.9%) and 10 cases (5.3%). respectively. According to the Bolger's classification, there were 13 sites (41.9%) of type I with the mean VER of 0.71, 14 sites (45.2%) of type II with the mean VER 0.50, and 4 sites (12.9%) of type III with the mean VER of 0.27. The most common anatomical anomalies in both of the unilateral and bilateral PMSH were zygomatic (90.3%) and alveolar pneumatization (90.3%); the second most common abnormal finding was high maxillary sinus floor (77.4%). Of the anatomical variations, the frequency of uncinate process abnormalities (41.9%), paradoxical middle turbinate (32.3%) and Haller's cell (19.4%) were statistically significant. CONCLUSION: These results suggest that zygomatic and alveolar pneumatization, and high maxillary sinus floor are additionally important anatomical abnormalities associated with PMSH. Careful preoperative assessment of anatomical variations in the paranasal sinus CT scans may be essential to avoid incidental iatrogenic complications during functional endoscopic sinus surgery (FESS) or Caldwell-Luc operation in patients with PMSH.
Classification ; Humans ; Incidence ; Maxillary Sinus* ; Nasal Cavity ; Paranasal Sinuses ; Retrospective Studies ; Sinusitis ; Tomography, X-Ray Computed* ; Turbinates

The surgical approach to juvenile nasopharyngeal angiofibroma (JNA) is determined by the topographic localization, the extent of the tumor, and the experience of the surgical team.1)2) Current surgical options include lateral rhinotomy, midfacial degloving, transpalatal, infratemporal fossa, and transnasal approaches.2)3) Recently, the transnasal endoscopic surgical approach has sometimes been applied to treat benign tumors such as JNA.1)3)4) Transnasal endoscopic excision of a case of JNA limited to the left posterior nasal cavity, nasopharynx, and anterior pterygopalatine fossa was performed successfully on a 17-year old male patient. An endoscopic follow-up at postoperative two years did not indicate residual tumor or recurrence.
Adolescent ; Angiofibroma* ; Follow-Up Studies ; Humans ; Male ; Nasal Cavity ; Nasopharynx ; Neoplasm, Residual ; Pterygopalatine Fossa ; Recurrence

PURPOSE: This study was designed to examine the effects of an assertive training program on interpersonal relations, and psychiatric symptoms in patients with a mental disorder. METHOD: The study employed a quasi experimental design. The subjects included44 patients with a mental disorder, 20 in the experimental group, and 24 in the control group. Data was collected using structured questionnaires over a 3 month period. RESULTS: There were greater significant increases in scores of interpersonal relations and content of communication in the experimental group than the control group. Also, there was a greater significant decrease in the score of psychiatric symptoms in the experimental group than the control group. CONCLUSION: Assertive training has an effect on increasing content of communication and decreasing psychiatric symptoms.
*Social Behavior ; Social Adjustment ; Middle Aged ; Mental Disorders/*rehabilitation ; Male ; *Interpersonal Relations ; Humans ; Female ; *Behavior Therapy ; *Assertiveness ; Adult ; Adolescent

PURPOSE: To evaluate the effectiveness of foam sclerotherapy, we compared the clinical data and results of foam sclerotherapy with conventional sclerotherapy. METHOD: Ninety-three cases of varicose veins were retrospectively reviewed; these were treated by sclerotherapy from January 2000 to September 2005 (women: 82 cases, men: 12 cases, mean age: 43.7 years old). The enrolled cases were divided into the conventional sclerotherapy (CS) group (n=53) and the foam sclerotherapy (FS) group (n=40) according to the applied technique. We assessed the results with the disappearance scoring scale (DSS) and the satisfaction scoring scale (SSS). RESULT: In DSS, complete disappearance was reported as 28.3% by physicians and 30.2% by the patients in CS group and as 47.5% and 52.5% in the FS group, respectively. On the SSS, a satisfaction score scale above 3 (4: Good, 5: Very good) was reported for 79.1% in the CS group and 90.0% in the FS group, retrospectively. The average amounts of sclerosants used were significantly lower in the FS group (1.2+/-0.4 vials) than in the CS group (2.1+/-0.5 vials)(P=0.001). Post injection complications were retrospectively observed in 16.1% of all the patients, in 20.7% of the CS group and in 10.0% of the FS group. CONCLUSION: Sclerotherapy is a very effective and sufficient treatment for telangiectases or reticular varicose veins. Especially, foam sclerotherapy is more effective than conventional liquid sclerotherapy for the clinical results and the patient satisfaction, and it shows a with lower incidence of complications.
Humans ; Incidence ; Lower Extremity* ; Male ; Patient Satisfaction ; Retrospective Studies ; Sclerosing Solutions ; Sclerotherapy* ; Telangiectasis ; Varicose Veins*

PURPOSE: To evaluate the effectiveness of foam sclerotherapy, we compared the clinical data and results of foam sclerotherapy with conventional sclerotherapy. METHOD: Ninety-three cases of varicose veins were retrospectively reviewed; these were treated by sclerotherapy from January 2000 to September 2005 (women: 82 cases, men: 12 cases, mean age: 43.7 years old). The enrolled cases were divided into the conventional sclerotherapy (CS) group (n=53) and the foam sclerotherapy (FS) group (n=40) according to the applied technique. We assessed the results with the disappearance scoring scale (DSS) and the satisfaction scoring scale (SSS). RESULT: In DSS, complete disappearance was reported as 28.3% by physicians and 30.2% by the patients in CS group and as 47.5% and 52.5% in the FS group, respectively. On the SSS, a satisfaction score scale above 3 (4: Good, 5: Very good) was reported for 79.1% in the CS group and 90.0% in the FS group, retrospectively. The average amounts of sclerosants used were significantly lower in the FS group (1.2+/-0.4 vials) than in the CS group (2.1+/-0.5 vials)(P=0.001). Post injection complications were retrospectively observed in 16.1% of all the patients, in 20.7% of the CS group and in 10.0% of the FS group. CONCLUSION: Sclerotherapy is a very effective and sufficient treatment for telangiectases or reticular varicose veins. Especially, foam sclerotherapy is more effective than conventional liquid sclerotherapy for the clinical results and the patient satisfaction, and it shows a with lower incidence of complications.
Humans ; Incidence ; Lower Extremity* ; Male ; Patient Satisfaction ; Retrospective Studies ; Sclerosing Solutions ; Sclerotherapy* ; Telangiectasis ; Varicose Veins*