From March 1983, 20 patients had undergone reconstruction of the upper limb with 22 vascularized composite tissue grafts. The microsurgical procedures had several advantages for reconstruction of injured upper limbs as follows: 1. Free tissue transfer was quite an important and attractive procedure for reconstruction of an injured limb, expecially an upper limb. 2. Free vascularized transfer of composite tissue with its overlying skin was a reliable technique to obtain full thickness soft tissue coverage of a severely injured upper limb when more conservative procedures, such as the use of skin graft or local muscle flaps, had failed or were not feasible. 3. A simple skin flap could be transfered to close an open wound of the limb, but a sensory flap or a special flap such as a nail-skin, tendon-skin or muscle-skin flap was a much better donor for reconstructing the function of the upper limb. 4. When appropriate, the wrap-around procedure was the method of choice for thumb reconstruction because the great toe was preserved. The procedure provided length, stability and adequate sensibility for a functional pinch and grasp. 5. The cosmetic effect of a second-toe transplant might be inferior to the wrap-around flap, but it had the great advantage of being able to provide mobile joints in the reconstructed thumb. As far as the donor foot was concerned, no patients had real trouble functional impairment.
Extremities ; Foot ; Hand Strength ; Humans ; Joints ; Methods ; Microsurgery ; Skin ; Thumb ; Tissue Donors ; Toes ; Transplants ; Upper Extremity ; Wounds and Injuries

Acute thyroid abscess is an uneommon type of neck infection. We experieneed a case of staphylococcal thyroid abscess in 29 year old man, diagnosed by needle aspira~tion and culture of the aspirate. The patient had complained fever and slowly growing anterior neck swelling. Needle aspiration of the cold nodule prior to broad spectrum antibiotics was performed. After Surgical excision combined with antibiotics, he was discharged with elinical improvement. The laboratory diagnosis and clinical course was summarized and is reported with relevent references.
Abscess ; Anti-Bacterial Agents ; Clinical Laboratory Techniques ; Fever ; Humans ; Neck ; Needles ; Staphylococcus aureus ; Staphylococcus ; Thyroid Gland

BACKGROUND: Tracheal extubation causes hypertension and tachycardia. In susceptable patients, even this short period of hypertension and tachycardia can result in myocardial ischemia. The purpose of this study was to evaluate the effect of esmolol and diltiazem in attenuating cardiovascular responses to tracheal extubation. METHODS: Changes in heart rate, systolic and diastolic blood pressure were measured during extubation and emergence from anesthesia in 60 ASA physical status I patients to assess the effect of esmolol and diltiazem. The patients were randomly assigned to one of three groups (n=20 for each group) : saline 5 ml (as a control), 0.2 mg/kg diltiazem and 1.5 mg/kg esmolol. These medications were given 2 min before tracheal extubation. RESULTS: Both groups of diltiazem and esmolol were greater attenuating effect on changes of heart rate, systolic and diastolic blood pressure than control group. The inhibitory effect on changes of heart rate was greater with esmolol than diltiazem, but the attenuating effect on changes of systolic blood pressure was greater with diltiazem than esmolol. CONCLUSIONS: We concluded that a bolus dose of intravenous diltiazem 0.2 mg/kg or esmolol 1.5 mg/kg given at 2 min before extubation was of value in attenuating the cardiovascular changes occuring in association with tracheal extubation and emergence from anesthesia. Esmolol is more effective than diltiazem in attenuating the heart rate changes. Diltiazem is more effective than esmolol in attenuating the systolic blood pressures changes.
Airway Extubation* ; Anesthesia ; Blood Pressure ; Diltiazem* ; Heart Rate ; Humans ; Hypertension ; Myocardial Ischemia ; Tachycardia

The CD8(+)CD28(+) T cells have known to mediate major histocompatibility complex class I-restricted cytolysis and to secret an HIV-1 inhibitory factor. As HIV infection lead to dramatic changes within the cellular immune system, the cellular cytotoxicities decrease in the duration of the HIV infection. To determine the importance of the cellular cytotoxicities in long-term nonprogression, we tried to compare CD28 expression on total T, CD4(+) T, and CD8(+) T cells as one of methods for cellular cytotoxicity measurements between long-term nonprogressor and normal person or between long-term nonprogressor and rapid progressor. The median percentages and counts of CD4(+) T cells of the norrnal, the long-term nonprogressor, and the rapid progressor groups were 39.9 and 0.96 * 10(9) cells/L, 24.6 and 0.58 * 10(9) cells/L, 9.9 and 0.15 * 10 cells/L, respectively. As a result of comparison of the cells having CD28 surface molecules on CD8(+) T cells in the long-term nonprogressor and the rapid progressor group, they showed over 5 times lower than that in the normal group. Especially, the long-term nonprogressor regarded to the healthy HIV-infected patient showed much lower CD28 expression on total T, CD4(+) T, and CD8(+) T cells than those of the normal person. The proportions of CD4'CD28 T and CD3CD28 T cell subsets showed the significant difference between the LTNP and the RP group. In conclusion, although HIV-infected patients were LTNPs having the steady CD4(+) T cell counts and no clinical symptoms, we suggested that HIV led to abnormality within the lymphocyte subsets such as the altered expression of CD28 molecules on various T cell subsets and this result would cause deficiency of host immune function and failure of control of HIV replication by anergy in T cell subsets.
Cell Count ; HIV ; HIV Infections ; HIV-1 ; Humans ; Immune System ; Lymphocyte Subsets ; Major Histocompatibility Complex ; T-Lymphocyte Subsets* ; T-Lymphocytes

Although replacement therapy with insulin can prevent acute metabolic disorder in patients with IDDM (insulin dependent diabetes mellitus), it does not permanently restore glucose homeostasis. Recently it has been reported that islet transplantation could completely correct the glucose metabolic abnormalities and prevent further progression of the secondary complications of IDDM. For successful transplantation, the isolated islets should be prepared without loss of viability, while their immunogenicity being suppressed to reduce graft rejection. The present study was aimed to determine the optimal condition of islet culture, and to transplant them into the digestive organs including gastroin-testinal wall and salivary gland. For islet culture, pancreatic islets were isolated by a modified collagenase digestion technique from rats and cultured for 24, 48 and 72 hours in RPMI-1640 containing 0, 5.6 and 16.7 mM glucose. The viability of islets was evaluated by detection of insulin mRNA expressed in islet beta-cells using the in-situ hybridization and northern blot analysis, while their insulin content was examined by immunocytochemistry. Insulin mRNA was significantly reduced after 48 hours of culture in the islets incubated with absence of glucose, while distinct immunoreaction for insulin remained in the same islet. On the other hand, the islets cultured with normoglycemic (5.6 mM glucose) and hyperglycemic (16.7 mM glucose) conditions showed a normal or excessive transcription of insulin gene after 72 hours, respectively. These results indicate that biosynthetic activity of islets could be maintained longer than 72 hours without alteration of viability when they were cultured in normoglycemic condition. Therefore, we used islets cultured for 72 hours with 5.6 mM glucose for transplantation. The islets were implanted into the submucosal wall of the stomach and duodenum as well as into the parenchyme of the submandibular gland of the streptozotocin-induced diabetic rats. The transplanted islets in the gastrointestinal wall were abolished in 72 hours, while the islets injected into the submandibular gland retained normal cellular structure with viability for longer period. The beta-cell in the submandibular gland showed similar immunoreactivity for insulin compared to that of normal islets. However, they showed gradual infiltration of lymphocytes and beta-cell destruction at 10~14 days after transplantation. We suggested that the submandibular gland could be recommended as an alternative site for islet transplantation, because it is very easy to access for transplantation and provides the structural and functional similarities to pancreas in which the islets spontaneously grow.
Animals ; Blotting, Northern ; Cellular Structures ; Collagenases ; Diabetes Mellitus, Type 1 ; Digestion ; Duodenum ; Glucose ; Graft Rejection ; Hand ; Homeostasis ; Humans ; Immunohistochemistry ; Insulin ; Islets of Langerhans ; Islets of Langerhans Transplantation ; Lymphocytes ; Pancreas ; Rats* ; RNA, Messenger ; Salivary Glands ; Stomach ; Submandibular Gland ; Transplantation

No abstract available.
Peripheral Arterial Disease*

OBJECTIVES: It is widely accepted that estrogen has favorable effects on cardiovascular diseases, especially in the postmenopausal women. Endothelin-1(ET-I), released from the vascular endothelium, is a 21-amino acid peptide with strong vasoconstrictor activity. However, the effect of estrogen on the vasoconstriction to ET-1 has not been extensively studied. METHODS: To investigate the effect of estrogen (175beta-estradiol) on the vascular contraction to ET-1, porcine coronary artery(PCA) rings were suspended in organ chambers(37 degrees C, 95% O2/5% CO2) for measurement of isometric tension change. Endothelium was removed mechanically if necessary. In acute experiments, vascular rings were preincubated for 15minutes with 3different concentrations of 170beta-estradiol(10(-6), 10(-5), 10(-4)M) and concentration-contraction curves to cumulative doses of ET-1 were constructed. In the experiments after a longer exposure to 17beta-estradiol, the vessels with endothelium were exposed in the 5% CO2 incubator to 3different concentrations of 17beta-estradiol(10(-9), 10(-8), 10(-7)M) for 44-50 hours, and then concentrationcontraction curves to ET-1 were obtained. RESULTS: Incubation for 15minutes with 170beta-estradiol(10(-4)M) inhibited ET-1-induced contraction in the vessels with endothelium(area under the curve and maximal contraction, p<0.05 compared with control). This effect persisted regardless of the sex and the presence or absence of the endotheliurn. Incubation of the vessels far a longer time with 170beta-estradiol(44-50 hours) resulted in the inhibition of maximal contraction to ET-1(p<0.05) by a lower concentration of 175beta-estradiol(10(-7)M) than in acute experiments in male PCA rings, but an enhanced contraction to ET-1(area under the curve; p<0.05) by 10M of 175beta-estradiol was observed in female PCA rings. CONCLUSION: Short-time incubation with 17Pbeta-estradiol has an inhibitory effect on the contraction to ET-1 in PCA rings. This effect is independent of the presence of the endothelium and the sex of the pigs. A longer incubation with 17beta-estradiol results in a similar inhibitory effect on male(but not female) PCA rings, suggesting that a sex-related difference may exist concerning the effect of 17beta-estradiol on ET-1-induced contraction.
Cardiovascular Diseases ; Coronary Vessels* ; Endothelin-1* ; Endothelins ; Endothelium ; Endothelium, Vascular ; Estrogens ; Female ; Humans ; Incubators ; Male ; Passive Cutaneous Anaphylaxis ; Swine ; Vasoconstriction

PURPOSE: We conducted a study on patients who underwent hip joint arthroplasty because of unstable femur intertrochanteric fractures with greater trochanter bony fragments. After dividing patients into three groups depending on their fracture patterns, we evaluated the clinical and radiological outcomes of different operation methods applied to each of these groups. MATERIALS AND METHODS: Using Evan's classification, we defined an unstable intertrochanteric fracture as those characterized as stage 4 or 5. Of the 137 patients presenting with an intertrochanteric fracture with osteoporosis (bone mineral density, <−2.5) between March 2014 and October 2015, 63 met the eligibility criteria and were included in this study. Next, patients were divided into three groups based on their greater trochanter fracture patterns (discerned with three-dimensional computed tomography images); different fixation methods were applied to each group by a single orthopaedic surgeon. RESULTS: Taken as a whole, 50 out of 63 patients experienced no reduction in walking distance in their daily lives. Harris hip score increased from 74.8 to 85.7 point and we considered this a relatively good result. Radiologically, we observed complete bone union in 62 cases (98.4%); the lone exception was in a patient who experienced osteolysis. There were also 3 cases who removed greater trochanter reattachment device due to broken implant and 1 case of dislocation. CONCLUSION: The different fixation methods applied to three distinct groups with varying fractures patterns were successful in achieving proper reduction and fixation of greater trochanteric fractures. We also observed reduced bone union periods when arthroplasty was performed in patients with unstable intertrochanteric fractures. Lastly, we believe these approaches may also aid in achieving early ambulation and early rehabilitations.
Arthroplasty* ; Classification ; Dislocations ; Early Ambulation ; Femur* ; Hip ; Hip Fractures* ; Hip Joint ; Humans ; Methods* ; Miners ; Osteolysis ; Osteoporosis ; Walking

PURPOSE: To analyze the end results of the treatment for patients with wide gap non-unions of the long bones in the lower extremities. MATERIALS AND METHODS: A total of 62 cases of wide gap unions, with a mean age of 38 years, were included for analysis. Study cohort included six children under the age of seven years. The average size of established bone defect was 7 cm (4-23 cm). Bone defects under 7 cm were treated with plating and various bone grafts, and those over 7 cm were managed with vascularized fibular graft (VFG), distraction-osteogenesis, tibial strut, plating and etc. Two boys with a defect of the whole tibia but with an intact fibula were treated with tibialization of intact fibula and with rotation-plasty of the leg. Their end results were evaluated by the time of bony union in accordance with the treatment of defect size of the long bone as well as their age. RESULTS: Bony unions were obtained for an average period of at least 27 months. Fifty-one cases showed an average leg-length discrepancy of 2.8 cm, and 11 cases showed no leg-length discrepancy. The VFG, distraction-osteogenesis, and tibial cortical-strut graft and plating were the most effective methods for non-unions of wide, long bone defections (>7 cm). The prognosis was more favorable in children, muscular femur, and in cases with tibial defect but intact fí bula. CONCLUSION: Various bone union techniques should be considered carefully, considering the ages of patients and the size of bone defects. Due to severe physical and mental disabilities of patients during the long-treatment period, specialized orthopedic doctors for trauma and mental care were necessary.
Child ; Cohort Studies ; Femur ; Fibula ; Fractures, Open ; Humans ; Leg ; Lower Extremity* ; Orthopedics ; Prognosis ; Tibia ; Transplants

PURPOSE: To analyze the end results of the treatment for patients with wide gap non-unions of the long bones in the lower extremities. MATERIALS AND METHODS: A total of 62 cases of wide gap unions, with a mean age of 38 years, were included for analysis. Study cohort included six children under the age of seven years. The average size of established bone defect was 7 cm (4-23 cm). Bone defects under 7 cm were treated with plating and various bone grafts, and those over 7 cm were managed with vascularized fibular graft (VFG), distraction-osteogenesis, tibial strut, plating and etc. Two boys with a defect of the whole tibia but with an intact fibula were treated with tibialization of intact fibula and with rotation-plasty of the leg. Their end results were evaluated by the time of bony union in accordance with the treatment of defect size of the long bone as well as their age. RESULTS: Bony unions were obtained for an average period of at least 27 months. Fifty-one cases showed an average leg-length discrepancy of 2.8 cm, and 11 cases showed no leg-length discrepancy. The VFG, distraction-osteogenesis, and tibial cortical-strut graft and plating were the most effective methods for non-unions of wide, long bone defections (>7 cm). The prognosis was more favorable in children, muscular femur, and in cases with tibial defect but intact fí bula. CONCLUSION: Various bone union techniques should be considered carefully, considering the ages of patients and the size of bone defects. Due to severe physical and mental disabilities of patients during the long-treatment period, specialized orthopedic doctors for trauma and mental care were necessary.
Child ; Cohort Studies ; Femur ; Fibula ; Fractures, Open ; Humans ; Leg ; Lower Extremity* ; Orthopedics ; Prognosis ; Tibia ; Transplants