BACKGROUND: The concentration of the blood including ACTH, catecholamine, serum prolactine, cortisol is increased due to responding on stress by carrying out endotracheal intubation upon the mutiple trauma patients who were taken to the emergency room. Diazepam is a kind of benzodiazepine pharmacon and common pharmacon used for stability of the patients, relief and pretreatment as a booster for the relaxation of skeletal muscle. This research aims to know how effectively medication of diazepam before endotracheal intubation helps to constrain the reaction on the part of cardiovascular system due to laryngoscopy and endotracheal intubation, and makes concentration of catecholamine in blood changed. METHODS: The subjects are consisted of the patient asked for endotracheal intubation instantly, suffering from caput trauma (GCS 8.0) among the multiple trauma patient, more than 20-year-old who were taken to the emergency room in Chosun university hospital from October 1, 1995 to September 30, 1996. They were decided into 2 classes, 30 people each class, and one (group I ) was carried out endotracheal intubation without injecting diazepam,0.3 mg/kg, and the other (group II) was done with the endotracheal intubation by injecting diazepam, 0.3mg/kg. Group I and group II were measured blood pressure and heart rate before intubation and at 1, 3, 5, 7 minute after endotracheal intubation, sampled arterial blood from femoral artery, and then compared and analyzed. All of the data were recorded by mean, standard deviation, and percentage and repeated measures ANOVA test was used for the statistical test and the data was regarded as statistically significant when p value is below 0.05. RESULTS: 1) They were no significant differences statistically between 2 groups in the distribution of the age, weight, sex of the patients. 2) The changes in the systolic blood pressure had no statistical significance in the comparison between group I and group II, but diastolic blood pressure and the change of heart rate had statistical significance because p value was shown below 0.05. 3) Norepinephrine of blood was significantly lower in group II than group I. 4) Epinephrine of blood was significantly lower in group II than group I. CONCLUSION: It was shown that medication of diazepam before endotracheal intubation made stability of the patients and it changed significantly the reaction on the part of cardiovascular system from stress caused by laryngoscopy and endotracheal intubation. So it will be a good thing to inject diazepam for pretreatment to bring relief of the patients and cardiovascular stability before endotracheal intubation.
Adrenocorticotropic Hormone ; Benzodiazepines ; Blood Pressure ; Cardiovascular System ; Diazepam* ; Emergency Service, Hospital ; Epinephrine ; Femoral Artery ; Heart Rate ; Humans ; Hydrocortisone ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Multiple Trauma* ; Muscle, Skeletal ; Norepinephrine ; Prolactin ; Relaxation ; Young Adult

No abstract available.
Humans

Six thumb reconstructions and one index reconstruction were performed by use of the wrap-around technique. All successful digital reconstructions were reviewed at an average of 37 months after surgery. There were complications related to the digits in three patients ; these included pin site infection (1), malrotation (1), and nail deformity (1). But we considered that function and cosmesis were excellent with a 100% viability rate. All patients regained protective sensation and sttained two-point discrimination (average 10mm). The wrap-around technique represents an esthetically and functionally excellent procedure of digit reconstruction for amputation at the level of metacarpo-phalangeal joint or distal to it.
Amputation ; Congenital Abnormalities ; Discrimination (Psychology) ; Fingers ; Humans ; Joints ; Sensation ; Thumb

Thirty one free vascularized fibula bone grafts were performed for treatment of osteonecrosis of the femoral head in 26 patients, 24 men and 2 women aged from 16 to 48(mean:32 years). Twenty one patients had unilateral disease. Five patients had bilateral disease underwent staged bilateral free vascularized fibula grafts three months apart. Associated etiological factors included alcohol(9 patients), steroid(7 patients), and trauma(one patient). The condition was considered idiopathic in the remaining 9 patients. Radiologic staging by Ficat included stage 1 in one hip, stage II in 15 hips, stage III in 14 hips, and stage IV in one hip. A skin island flap was used for monitoring purpose for the grafted fibula. One monitoring, flap was necrotized due to vascular occlusion but the fibula bone graft was left in place to use as a nonvascularized bone graft. Average follow-up period was 21 months in 31 hips. Pain was relieved in 28 hips(93.3 percent) and aggravated in 2 hips(6.7 per cent). On radiographic evaluation, 26 hips(86.7 per cent) demonstrated excellent preservation of the femoral head contour. Progressive collapse of the femoral head (greater than 1-2 mm) occurred in 2 hips, i mm depression in one hip with stage III and 2 mm collapse in one hip with stage IV. In conclusion, the free vascularized fibula bone graft is an excellent treatment modality for preserving the femoral head and relieving symptoms in cases of the osteonecrosis of the femoral head.
Depression ; Female ; Fibula* ; Follow-Up Studies ; Head* ; Hip ; Humans ; Male ; Osteonecrosis* ; Skin ; Transplants

The number of cancers in the head and neck areas has been increasing due to the increasing life span of the patients and a free flap is a common procedure to reconstruct defect in the head and neck area. From March 1990 to February 1998, 105 patients underwent 110 free flap operations after head and neck cancer ablation and they were reviewed retrospectively. Among 110 free flaps, 93 are forearm flaps, 6 jejunal flaps, 5 vascularized fibular osteocutaneous flaps, 2 lateral arm flaps, 2 rectus abdominis myocutaneous flaps and 1 latissimus dorsi muscle flap and 1 latissimus dorsi myocutaneous flap. Sixty-five radial forearm flaps and 4 ulnar forearm flaps were utilized in patched type and 24 radial forearm flaps in tubed type mainly for the reconstruction of intraoral and hypopharyngeal defects. Sis jejunal flaps were utilized for the esophageal reconstruction and 5 vascularized fibular osteocutaneous flaps for the mandibular reconstruction. The remaining flaps were for the reconstruction of other areas of head and neck.Overall survival rate of the flap was 95.5%. Immediate complications were fistula formation(3 cases), total flap loss (4 cases) or partial flap loss(3 cases) and donor site problems(10 cases). Superior thyrodial artery was the most commonly used recipient artery(89 cases) which was followed by facial artery, lingual artery and transverse cervical artery. Size discrepancy was not remarkable between the donor and recipient arteries. However, there was usually a marked size discrepancy between donor and recipient veins. More than two venous anastomoses were performed to increase the success rate of the flap surgery. An average follow-up period was 38 months ranging from 3 months to 6 years. There was no patient who died during or right after the operations, but 23 patients died due to recurrence of tumors or underlying heart disease during the follow-up period. Remaining patients lived well excluding 6 late postoperative complications such as 4 cases of esophageal stenosis and 2 cases of osteoradionecrosis. We conclude that free flap reconstruction after head and neck cancer ablation improves the quality of life and minimizes the loss of function.
Arm ; Arteries ; Esophageal Stenosis ; Fistula ; Follow-Up Studies ; Forearm ; Free Tissue Flaps* ; Head and Neck Neoplasms* ; Head* ; Heart Diseases ; Humans ; Mandibular Reconstruction ; Myocutaneous Flap ; Neck ; Osteoradionecrosis ; Postoperative Complications ; Quality of Life ; Rectus Abdominis ; Recurrence ; Retrospective Studies ; Superficial Back Muscles ; Survival Rate ; Tissue Donors ; Veins

Drowning is the second most common cause of accidental death of children in Korea. But the study of near-drowning is very rare in Korea. The purpose of our study is to determine the factors that may influence survival on the basis of submersion time, consciousness state upon admission to hospital, the kinds of water, laboratory findings and neurological outcomes. The survey was performed by a retrospective cohort study on 28 near drowning victims of less than 15 years of age who were admitted to the emergency room in the Chosun University Hospital between May 1988 & May 1997. The results were as follows 1) Sex distribution was 22 males and 6 females. 2) Submersion time was (5 minutes in 9 cases, 5-9 minutes in 6 cases,10-14 minutes in 5 cases,15-19 minutes in 3 cases, > or =20 minutes in 5 cases. 3) Comatose patients upon arrival were 6/7 cases in the death group(86%) and 2/21 cases in the improved group(10%). they had unfavorable outcomes(P<0.05). 4) The first pH value was mean 7.02)0.12 in the death group and mean 7.31 +/-0.13 in the improved group. there was a statistically significant difference between the death and the improved group(P<0.05). 5) The patients who had increased blood glucose concentration were all 7 cases in the death group and 12/22 cases in the improved group(54%). The mean blood glucose concentration was mean 424.7235.6mg/dl in the death group and mean 140.182.7mg/dl in the improved group. There was a statistically significant difference between the death and the improved group(P<0.05). 6) The patients who had pulmonary edema upon arrival were all 7 cases in the death group and 1/21 cases in the improved group(18%). They had unfavorable outcomes(P<0.05). 7) The patients who had been submerged more than 15 minutes were all 7 cases in the death group and 6/21 cases in the improved group(5%). They had unfavorable outcomes(P<0.05). We conclude that pediatric victims of near-drowning can be assigned to high or low likelihoods of unfavorable outcomes with the use of five variables, comatose mentation upon arrival, decreased initial blood pH, increased initial blood glucose concentration, pulmonary edema, and maximum submersion time estimated longer than fifteen minutes. This prediction rule may be useful if it can be validated in another cohort.
Blood Glucose ; Child* ; Cohort Studies ; Coma ; Consciousness ; Drowning ; Emergency Service, Hospital ; Female ; Humans ; Hydrogen-Ion Concentration ; Immersion ; Korea ; Male ; Near Drowning ; Pulmonary Edema ; Retrospective Studies ; Sex Distribution

The following conclusions were obtained from the non-reconstructed and reconstructed subtraction images of the standard intraoral radiographs which were taken with paralleing technique with Rinn XCP only and with occlusal bite registration for geometric standardization using bilateral mandibular premolar and molar regions of two dry humad skulls. 1. The SD of the overall subtraction images of the premolars and molars of the non-reconstructed, tnat is, the manual superimposition showed statistically significant difference between the non-registered and registered groups. 2. In non-reconstructed and non-registered cases, the quality of the subtraction images were improved when superimposition was focally done and this was more evident in areas where the radiographic imaged tend to be distorted due to anatomic readons. 3. In non-restructed and registered cases, the subtraction images were consistent regardless of the anatomic site or the focus superimposition. This means that the geometric standardization with only occlusal bite registration could produce serial radiographs which is suitable for subtraction. 4. The SD of the overall subtraction images of the premolars and molars of the reconstructed, that is, the automatic superimposition showed statistically insignificant difference between the non-registered and registered groups. This means that using reconstruction, subtraction radiography is possible without occlusal bite registration. 5. In reconstructed and non-registered cases, compatible quality of the subtraction images were obtained regardless of the anatomic site or area of the corresponding points. 6. In reconstructed and registered cases, best subtraction images whose quality showed sensitivity to the areas of corresponding points were obtained.
Bicuspid ; Jaw Relation Record ; Molar ; Radiography* ; Skull

Reconstruction of soft tissue defect with exposure of the tendons and bone in the lower third of the leg and the heel represents a challenge to plastic surgeons. The sural artery flap is a fasciocutaneous flap supplied by the sural artery that accompanies the sural nerve and connects with a septocutaneous perforator of the peroneal artery via a suprafascial network of vessels. For the coverage of soft tissue defects, we operated on 10 patients using a distally-based sural artery flap. The sites of the soft tissue defect were the lower third of the leg in 7 cases and the heel in 3 cases. The size of flap varied from 3.5x4cm to 12x18cm. Nine of 10 flaps survived completely. One flap in which the sural nerve was preserved showed partial necrosis but healed spontaneously. Two flaps showed slightly venous congestion which disappeared after a few days. The advantages of the sural flap are a reliable blood supply, easy and quick elevation of the flap, preservation of the major artery and minimal donor site morbidity. The disadvantage of the flap is hypoesthesia at the lateral part of the foot. In conclusion, the distally-based sural artery flap can be used safely for soft tissues coverage in the lower third of the leg and the heel.
Arteries* ; Foot ; Heel ; Humans ; Hyperemia ; Hypesthesia ; Leg ; Necrosis ; Sural Nerve ; Tendons ; Tissue Donors

The purpose of this study was to investigate the possibility of distraction osteogenesis in membranous onlay bone graft on the mandible and to clarify the histology of bone repair during distraction osteogenesis in the membranous onlay bone in a dog model. Four dogs, 5 months of age at the beginning of the experiment, were used for this study. The zygomatic arch was exposed in the subperiosteal plane and the full-thickness zygomatic arch was harvested to 3 centimeters in length. The lateral surface of the mandibular body was exposed in the subperiosteal plane and the membranous onlay bone graft was performed with firm contact using screws. The osteotomy on the membranous onlay bone graft and underlying mandibular body was carried down week 1 in dog 1, week 2 in dog 2, week 3 in dog 3, and week 4 in dog 4 after membranous onlay bone graft. The external distraction device was applied to the mandibular body. Mandibular distraction was started 7 days after the operation at a rate of 1mm per day for a total of 10 mm distraction over 10 days. After completion of distraction, the distraction device was left in place for 6 weeks bony consolidation of the distracted area. Radiographs were carried out at 2 weeks, 4 weeks and 6 weeks after distraction. New bone between the native underlying mandibular segments was generated in the distracted zone in all dogs. The new bone between the native underlying mandibular segments was generated in the distracted zone in all dogs. The new bone between segments of membranous onlay bone graft was not generated in dog 1, but it was generated in dogs 2, 3 and 4. However, in dog 2 and 3, the new bone between segments of the distracted membranous onlay bone graft presented less firmness with fibrous tissue than that of the native underlying mandibular segment. Histologically, the distracted gap between segments of the membranous onlay bone graft was composed of much fibrous tissue in the central zone while activated osteoblastic cells formed new bone in the margins of the distracted gap in dogs 2 and 3. In dog 4, there were abundant osteoblastic activities in the distracted gap and the new bone appeared as nearly-normal cortical bone. In conclusion, these findings suggested that membranous onlay bone graft had an osteogenic capacity and that distraction osteogenesis was possible in membranous onlay bone graft.
Animals ; Dogs* ; Inlays* ; Mandible ; Osteoblasts ; Osteogenesis, Distraction* ; Osteotomy ; Transplants* ; Zygoma

Cardiac lymphangioma is one of the rarest, primary, benign tumor of the heart. We report a case of cardiac lymphangioma, which was diagnosed with CT and MRI in a 50 years old female. Plain chest film showed minimal enlargement and globular shape of the heart. On CT scan, abnormal fluid density mass lesion was noted within pericardial sac. The signal intensity was lower on T1-weighted image and hgher on T2-weighted image than that of the myocardium and located along the left atrioventricuar groove. Several small low signal spots representing hemorrhage were seen within this lesion.
Female ; Heart ; Hemorrhage ; Humans ; Lymphangioma* ; Magnetic Resonance Imaging ; Myocardium ; Thorax ; Tomography, X-Ray Computed