BACKGROUND: Stellate ganglion block (SGB) is known to increase blood flow to the innervations area of the stellate ganglion. Near infrared spectroscopy reflects an increased blood volume and allows continuous, non-invasive, and bedside monitoring of regional cerebral oxygen saturation (rSO2). We investigated the influence of SGB on bilateral cerebral oxygenation using a near infrared spectroscopy. METHODS: SGB was performed on 30 patients with 1% lidocaine 10 ml using a paratracheal technique at the C6 level and confirmed by the presence of Horner's syndrome. The blood pressure (BP), heart rate (HR) and rSO2 were measured before SGB and 5, 10, 15 and 20 minutes after SGB. Tympanic temperature of each ear was measured prior to SGB and 20 minutes after SGB. RESULTS: The increments of the rSO2 on the block side from the baseline were statistically significant at 5, 10, 15 and 20 minutes. The rSO2 on the non-block side compared with the baseline, however, decreased at 15 and 20 minutes. The difference between the block and the non-block sides was significant at 15 and 20 minutes. The BP at 10, 15 and 20 minutes was increased and the HR was increased at 10 and 15 minutes. CONCLUSIONS: We observed an increment of the rSO2 on the block side from the baseline; however, the rSO2 on the non-block side decreased.
Blood Pressure ; Blood Volume ; Ear ; Heart Rate ; Horner Syndrome ; Humans ; Lidocaine ; Oxygen ; Spectrum Analysis ; Stellate Ganglion

Overaction of the inferior oblique(IO) muscle is manifested by elevation of the adducted eye and from the clinical point of view there are two types of overaction. The primary type is of unknown cause, whereas the secondary type is usually related to the palsy of the ipsilateral superior oblique or contralateral superior rectus. An ultrastructural study on the overacting IO muscles was performed compared to normal IO muscles by electron microscopy. Of 16 biopsies of overacting IO muscles, four had primary overacting inferior obliques and twelve had secondary overacting inferior obliques due to paralysis of superior oblique muscle. Additional four IO muscle, obtained from patients with intraocular diseases served as control specimens. The most striking abnormalities were aggregations of mitochondria and degenerating mitochondrial profiles and increased vacuolization in primary and secondary overacting muscles. Many muscle fibers were in different stages of atrophy, and hypertrophy and regeneration of muscle fibers were sometimes visible. The results suggest that the primary overacting IO muscle might be the result of a paresis of the superior oblique muscle.
Biopsy ; Humans ; Mitochondria/ultrastructure ; Ocular Motility Disorders/*pathology ; Oculomotor Muscles/*ultrastructure ; Ophthalmoplegia/pathology ; Vacuoles/ultrastructure

Nipple reconstruction methods include various techniques, such as the local flap technique, free nipple grafting, and filler injection. The local flap technique can provide less donor site morbidity than a free nipple graft, but leaves an additional scar near the nipple. We present a novel method for reconstruction of the nipple using a flap located on one side of the nipple. The flap has a teardrop shape consisting of a circle and two wings folded to one side. The two wings form a pillar and cap, and the de-epithelialized tip of one wing fills the internal dead space of the new nipple. We applied this nipple reconstruction technique in the case of a 61-year-old patient who had a vertical scar due to inverted-T reduction mammoplasty. The patient had lost her nipple in previous breastconserving surgery. The immediate postoperative nipple projection was 10 mm. At the 7-month follow-up visit, the nipple projection was 7.5 mm. The teardrop flap is an innovative technique that leaves no additional scar by using the scar already present on one side of the nipple.

OBJECTIVE: To evaluate the efficacy of MRI in bladder or rectal invasion of cervical cancer. METHODS: Between January 2000 and December 2005, 106 cervical cancer patients who underwent cystoscopy or sigmoidoscopy examination retrospectively compared with results of the MRI finding. A 5-point invasion score was used to determine bladder or rectal invasion in MRI (1 = no invasion, 3 = serosal invasion, 5 = definite mucosal invasion). Score of 3 or above was suspicious for both rectal and bladder invasion. RESULTS: Eighty one patients with negative for both rectal and bladder invasion in MRI were normal in cystoscopy and sigmoidoscopy. MRI identified 17 patients with suspected bladder invasion, 7 patients had confirmed bladder invasion in cystoscopy. MRI identified 11 patients with suspected rectal invasion, 1 patients had confirmed rectal invasion in sigmoidoscopy. The detection of rectal and bladder invasion by MRI had a negative predictive value of 100%. CONCLUSION: The use of a 5-point scoring system for predicting rectal or bladder invasion in MRI is accurate in detecting cervical cancer patients with no evidence of rectal or bladder invasion. The cervical cancer patients with no evidence of rectal or bladder invasion in MRI can obviate invasive cystoscopy and sigmoidoscopy.
Cystoscopy ; Diagnosis* ; Humans ; Magnetic Resonance Imaging* ; Retrospective Studies ; Sigmoidoscopy ; Urinary Bladder* ; Uterine Cervical Neoplasms*

No abstract available.
Cardiomyopathies* ; Peripartum Period*

The authors present the one case of a 22-year-old man admitted with intermittent quadriparesis and respiratory difficulty. On investigation, atlantoaxial instability and upper cervical cord compression due to abnormal soft tissue were revealed. We have performed transoral decompression and biopsy, and then posterior transarticular facet screw fixation with interspinous wiring and fusion. We could obtain immediate and long-term postoperative stability with Philadelphia collar only. The pathologic examination reveald connective soft tissue hypertrophy due to chronic mechanical irritation.
Biopsy ; Decompression* ; Humans ; Hypertrophy ; Quadriplegia ; Young Adult

OBJECTIVE: To evaluate the therapeutic value of conization using right-angled triangular shape loop cone biopsy excisor in patients with CIN 3 who want preserve the uterus. METHODS: A retrospective review of 64 patients was performed who underwent therapeutic conization for CIN 3 by using right-angled triangular shape loop cone biopsy excisor from January 2000 to August 2005. RESULTS: The mean duration of 64 follow-up patients who had conization for therapeutic purpose was 21.5 months (range 10-68). Their mean age was 41.1 years old and mean parity was 1.7. Two of 64 patients had CIN 3 on exocervix margin. During the followed up period, only one person (1/64) had relapse of CIN 3, hence, a simple hysterectomy was done. CONCLUSION: Right-angled triangular shape loop cone biopsy excisor is more effective than U-shaped loop with low rate of margin positive and recurrent rate in conservative treatment in CIN 3 patients who want to preserve uterus or fertility.
Biopsy ; Cervical Intraepithelial Neoplasia* ; Conization* ; Female ; Fertility ; Follow-Up Studies ; Humans ; Hysterectomy ; Parity ; Recurrence ; Retrospective Studies ; Uterus

Patients with medullary spongy kidney(MSK) who recurrently form and pass stones are in danger of developing obstructive nephropathy. Since extracorporeal shock wave lithotripsy (ESWL) was introduced to treat urinary tract stones, the shock wave application to MSK with stones has been performed. Between February, 1990 and August, 1992, 11 renal units in 7 patients were diagnosed as stones in MSK on intravenous urography. These patients were all symptomatic with hematuria and/or flank pain, and then treated by ESWL. The number of stone-burden minor calyces was 1 to3 in 2 cases( 18.2%), 4 to 6 in 8 cases ( 72.7% ) and 7 or more in 1 case(9.1%). The average numbers of treatment for these stones were 8.5, 13.4 and 4 sessions, respectively and the average storage was 386, 470 and 115, respectively. Reduction in the number and size of the stones on plain films was more than ?5% in 5 cases( 45.4%), 25 to 75% in 4 cases( 36.4%), and less than 25% in 2 cases( 13.2%). Serum creatinine, blood urea nitrogen, and creatinine clearance rate did not show any change after the treatments. The post-ESWL complication was only persistent gross hematuria for 4 days in 1 case( 14.3% ) In conclusion, although ESWL does not clear the stones completely, the ESWL is considered to be an effective procedure to prevent an obstructive nephropathy and to reduce the frequency of symptomatic stone passage in medullary spongy kidney with stones.
Blood Urea Nitrogen ; Creatinine ; Flank Pain ; Hematuria ; Humans ; Kidney* ; Lithotripsy* ; Nephrocalcinosis* ; Shock* ; Urinary Calculi ; Urography

Telecanthus is a common symptom accompanied by Waardenburg syndrome, a rare genetic disorder. The optimal surgery for telecanthus correction is still debated. A 28-year-old patient with Waardenburg syndrome underwent transnasal wiring canthopexy using a Y-V epicanthoplasty for telecanthus correction. A Mini-Monoka stent was used to prevent damage to the lacrimal apparatus. The intercanthal distance decreased from 50 mm to 43.2 mm. The easily designed Y-V epicanthoplasty incision provides sufficient operative field for oblique transnasal wiring, which is effective in properly positioning the medial canthal tendon. It has minimal scarring resulting in satisfactory cosmetic outcomes.
Adult ; Cicatrix ; Congenital Abnormalities ; Craniofacial Abnormalities ; Humans ; Lacrimal Apparatus ; Stents ; Tendons ; Waardenburg Syndrome

The authors report a case of superficial femoral arterial trauma caused by external fixator in 53 year-old male patient who had supracondylar fracture of femur due to automobile accident. After removal of external fixator, autogenous bypass graft was perfomed with reversed great saphenous vein. The occlusion of the graft occurred 3 months later, we thought that interposition graft in the chronic inflammatory and fibrotic tissue should be avoided.
Automobiles ; External Fixators ; Femoral Artery ; Femur ; Humans ; Male ; Middle Aged ; Rupture ; Saphenous Vein ; Transplants