No abstract available.
Breast* ; Carcinoembryonic Antigen* ; Humans ; Stomach*

In 1973, Daniel and Taylor reported the first successful microsurgical transplantation of the groin flap as a one-stage reconstrutive procedure. The free vascularized groin flap has several advantages, such as its potenitally large size, comfortable position of the patient during operation, minimal donor site morbidity, possible coverage of the donor site scar with a bikini, its multiple arterial and venous system, and the potential for incorporating bone with the overlying skin. The authors perfomed free groin flaps in 36 patients at Severance Hospital, Yonsei University College of Medicine from January 1985 to August 1988. The results were as follows : 1. Good results were obtained in 26 of 36 cases with a 72.2% success rate. The results were better in the upper extremity than the lower extremity. 2. The anatomical classification of the superficial circumflex iliac artery was as follows : a common origin of the superficial circumflex iliac artery and the superficial inferior epigastric artery in 39.5% of cases, an absent superficial inferior epigastric artery with a large compensatory superficial circumflex iliac artery in 36.8%, separate origins of the two vessels in 7.9%, and an origin from a profunda femoral artery in 15.8%. This result was similar to that of Daniel and Taylor. 3. The average diameter of the artery was 1.0mm and the average length of the vascular pedicle was 9.0mm. 4. The results were better in the end to side anastomosis than the end to end anastomosis, but there was no statistical significance. 5. In the 10 failed cases, free scapular flaps were performed in 4 cases, skin grafts in 5 cases, and the cross leg flap in one case. 6. The donor sites healed well by primary closure without functional disturbance except in one cases in which secondary closure was done. In conclusion, the free vascularized groin flap can be used without restriction as a onestage reconstruction of an extensive soft tissue injury of the extremity.
Arteries ; Cicatrix ; Classification ; Epigastric Arteries ; Extremities ; Femoral Artery ; Groin ; Humans ; Iliac Artery ; Leg ; Lower Extremity ; Skin ; Soft Tissue Injuries ; Tissue Donors ; Transplants ; Upper Extremity

Amniotic embolism is a fatal disease with an abrupt onset and rapidly deteriorating clinical course. Its clinical features are various and the prediction of its occurrence is very difficult. Understanding its pathogenetic mechanisms has increased over the past two decades. We report on a case of amniotic embolism along with its full clinical manifestations after a normal delivery in the young primigravida.
Embolism*

Voice changes developing after endotracheal intubation during right hemicolectomy with endotracheal intubation have been found to be due to a right recurrent laryngeal nerve palsy in 43-years-old male patient. It was likely that the inflated cuffed tube rode up to the level of the cricoid cartilage during the course of surgery as traction was placed on the endotracheal tube because the condenser humidifier and breathing circuit weighed heavy. Cuff overexpansion, in addition to muscle relaxation and decreased tracheal elasticity were considered as contributing factors of vocal cord palsy. We believe that tube traction and cuff overexpansion were the mechanism of vocal cord palsy in our patient. So we recommend the routine use of tube stand so that weigh of the breathing circuit does not transmit traction to the endotracheal tube. Concurrently, filling the cuff with a sample of the inspired mixture of gases, saline and 4% lidocaine in special cases or regular deflation of the cuff must be considered.
Cricoid Cartilage ; Elasticity ; Gases ; Humans ; Intubation, Intratracheal* ; Lidocaine ; Male ; Muscle Relaxation ; Respiration ; Traction ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

Extraskeletal Neoplasm Resembling Ewings Sarcoma was firstly reported with comprehensive review of 39 cases by L. Angervall and F.M. Enzinger in 1975. The tumors chiefly affected young adults and most commonly involved the soft tissue of lower extremity. Microscopically, they were consisted of solidly packed small, round or ovoid cells arranged in sheets or lobules, which were indistinguishable from those of the Ewings sarcoma of bone. The authors recently experienced a soft tissue sarcoma occurring in deltoid area of young male patient, which was diagnosed extraskeletal neoplasm resembling Ewings sarcoma. The case review is presented.
Humans ; Lower Extremity ; Male ; Sarcoma ; Sarcoma, Ewing ; Young Adult

OBJECTIVE: To determine the heating characteristics of needle-shaped duplex stainless steel thermoseeds, and to evaluate their effectiveness in the induction of hyperthermia in rabbit liver. MATERIALS AND METHODS: Thermoseeds of the two different shapes, L-shaped for single doses of hyperthermia and I-shaped for in-vitro study and repeated hyperthermic induction, were prepared. For the in-vitro study, an I-shaped thermoseed 0.23 mm in diameter and 25 mm long was placed inside a plastic tube filled with water. Heat was applied for 30 minutes within an induction magnetic field, and during this time changes in temperature were recorded using three thermocouples. For the in-vivo study, fifteen New Zealand white rabbits were divided into five equal groups. An I-shaped or L-shaped thermoseed was inserted in each rabbit's liver, and then placed within the center of the magnetic induction coil during a 30-minute period of hyperthermia. The rabbits in the first group were sacrificed immediately after hyperthermia was induced once, while those in the other groups were sacrificed at 1, 3, and 7 days, respectively, also after one induction. The remaining three rabbits were sacrificed 4 days after three consecutive daily treatment sessions. The resected segments of liver were subsequently evaluated histopathologically for the extent of coagulation necrosis caused by heating of the thermoseed. RESULTS: The in-vitro study demonstrated that the temperature in the thermoseed, which was 25.9 degree C before heating and 54.8 degree C after heating, rose rapidly at first but progressively less rapidly as time elapsed. Light microscopic examination of the rabbits' livers revealed coagulation necrosis and infiltration by inflammatory cells around the insertion site of the thermoseed. The maximum diameter of coagulation necrosis was 2.81+/-1.68 mm, and this occurred in the rabbits that were sacrificed 7 days after heat induction. CONCLUSION: Needle-shaped duplex stainless steel thermoseeds show temperature-dependent-type heating characteristics, and in rabbit liver, induced coagulation necrosis of surrounding tissues after heat is applied for 30 minutes. These thermoseeds may thus be useful for the induction of interstitial hyperthermia.
Animal ; *Body Temperature ; Hyperthermia, Induced/*instrumentation ; Liver/pathology/*physiology ; Necrosis ; Rabbits ; Stainless Steel ; Support, Non-U.S. Gov't

BACKGROUND: Recently, laparoscopic cholecystectomy becomes more favorite method than traditional open cholecystectomy. But postoperative pain control is still remaining problem. METHOD: Patients scheduled for elective laparoscopic cholecystectomy were assigned to two groups by simple randomization (15 patients per group). Group C (control) had no specific treatment and group B (bupivacaine) received 20 ml of 0.5% bupivacaine with epinephrine 1:200,000 before surgery. Immediately after the creation of a pneumoperitoneum, the surgeon sprayed the bupivacaine near and above the operation field. Operation was started 10 minutes after then. We attempted to investigate that the degree of postoperative pain which was assessed using the visual analogue scale (VAS) and the verbal rating scale (VRS) in the recovery room at postoperative 1 h., as well as the analgesic requirements during the first 24 h. postoperatively. RESULT: VRS of group B was significantly lower than group C (p<0.05), but VAS was not significantly different. Six patients in group B and only one in group C requested no analgesics. Group C had statistically more frequent request for analgesics than group B (p<0.05). CONCLUSION: The topical intraperitoneal anesthesia of 20 ml of 0.5% bupivacaine with epinephrine 1 : 200,000 before laparoscopic cholecystectomy is effective on the postoperative pain control. So, we recommmend that this simple and effective management is routinely treated in patients undergoing laparoscopic cholecystectomy.
Analgesics ; Anesthesia* ; Bupivacaine* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Epinephrine ; Humans ; Pain, Postoperative* ; Pneumoperitoneum ; Random Allocation ; Recovery Room

Pneumothorax and pulmomary edema can be produced as a complication during general anesthesia. The former which occurs during pressure ventilation is highly dangerous. It is characterized by a dramatic onset which is readily recongnized and demands immediate management. The latter may be developed after the upper airway obstruction has been relived due to the reduction of the intersitial hydrostatic pressure and increased capilary permeability. We experienced a case of pneumothorax and pulmonary edema that occurred after treatment for upper airway obstruction.
Airway Obstruction* ; Anesthesia, General ; Edema ; Hydrostatic Pressure ; Permeability ; Pneumothorax* ; Pulmonary Edema* ; Ventilation

BACKGROUND: Conventional nasotracheal intubation is commonly associated with injury to the passage tissues, such as the mucosal lining of the turbinates. Nasal polyp, teared mucosa and blood clots are potentially hazardous, since it lodge in a bronchus or obstruct a tracheal tube. So atraumatic intubation is very important point during nasotracheal intubation. METHODS: Fourty patients were divided into two groups, Mallinckrodt reinforced tube(n=20) and esophageal stethoscope inserted into the Mallinckrodt reinforced tube(n=20). The esophageal stethoscope was inserted into the Mallinckrodt reinforced tube until the distal end of the esophageal stethoscope reached about 5 mm beyond the distal end of the Mallinckrodt tube. The esophageal stethoscope was inflated using an air-filled syringe through a three-way stopcock. After defasciculating dose of pancuronium 0.5~1 mg intravenously, the patients were given thiopental 4~5 mg/kg, succinylcholine 1~2 mg/kg and lidocaine 1.5 mg/kg with 100% oxygen ventilation via face mask. After lubrication of the appropriate tracheal tube with jelly, it was gently advanced beyond the nasopharynx. The tube tip was manipulated into the larynx with the aid of a Magill intubating forceps. The incidence of epistaxis was compared between the two groups. RESULTS: The esophageal stethoscope inserted into the reinforced tube group had a significantly lower incidence of nasal bleeding than reinforced tube only (1/20 vs 18/20 : P<0.01). CONCLUSIONS: The esophageal stethoscope inserted into the reinforced endotracheal tube helps to minimize nasal bleeding during nasotracheal intubation.
Bronchi ; Epistaxis* ; Humans ; Incidence ; Intubation* ; Larynx ; Lidocaine ; Lubrication ; Masks ; Mucous Membrane ; Nasal Polyps ; Nasopharynx ; Oxygen ; Pancuronium ; Stethoscopes* ; Succinylcholine ; Surgical Instruments ; Syringes ; Thiopental ; Turbinates ; Ventilation

PURPOSE: Concept maps have been studied and used in diverse ways in scientific fields. This study aimed to investigate the usefulness and limitations of using concept maps during problem-based learning (PBL) in Year 3 medical students. METHODS: After each PBL module, we gathered concept maps from each pair of students and questionnaires about the usefulness and limitations of concept maps, and analyzed them. RESULTS: There were two types of concept maps, with some modifications. The students felt that concept maps provided overall understanding, analysis, and reorganization of problem cases. But, they also criticized shortage of disciplines related to drawing skills and rationales for each type of map. A strong need for expert maps and feedback for students resulted. CONCLUSION: For optimal use of concept maps, we recommend that the committee implements a plan to teach drawing skills, explains rationales for each type of map, and gives feedback to students.
Concept Formation ; Humans ; Problem-Based Learning ; Students, Medical ; Surveys and Questionnaires