Since the introduction of surgical microscope in microvesael surgery by Jacobson and Suarez in 1960, many surgeons have succeeded replantation, transplantation of composite segment of tissues so called free fiap-free bone graft and toe to hand transfer. McCraw & Furlow reported successfully transfered dorsal foot flap using dorsalis pedis artery in 1975 and Cobett transfered great toe to band for reconstruction of the amputated thunb. The authors experienced six cases of microsurgery using dorsalis pedis artery durig the recent two years in the department of Orthopaedic surgery of Soon Chun Hyang College and results in this paper. 1. Four cases out of six were dorsalis pedis free flap, one case was second toe to thumb and tbe other one was reconstruction of an amputated thumb in one stage using iliac bone graft and dorsalis pedis flap. 2. One case out of four cases of dorsalis pedis free flap was performed for reconstruction of contracted first web and the other cases were performed for foot. 3. Five cases out of six were successfully transfeed, one case which was toe to thumb was failed. The cause. of fail was probably due to post-operative hematoma. 4. Composite tissue using dorsalis pedis artery is one of the good donor site for composite tissue transfer for not only skin defect and scar contracture of the hand and foot but also reconstruction of the amputated fingers because it has several advantages; an acceptable thickness, a constant arterial supply, venous drainage through the saphenous system, and constant innervation through the terminal branches of the superficial and deep peroneal nerve.
Arteries ; Cicatrix ; Contracture ; Drainage ; Fingers ; Foot ; Free Tissue Flaps ; Hand ; Hematoma ; Humans ; Microsurgery ; Peroneal Nerve ; Replantation ; Skin ; Surgeons ; Thumb ; Tissue Donors ; Toes ; Transplants

No abstract available.
Holoprosencephaly*

PURPOSE: This study was undertaken to obtain basic data about the megakaryocyte colony formation of fetal liver cells by using immunocytochemical staining and ex vivo culture with growth factors. METHODS: The mononuclear cells were isolated from fetal liver and bone marrow with idiopathic thrombocytopenic purpura(ITP) and pancytopenia. These mononuclear cells were cultured in MegaCultTM-C(Stem Cell Tech, Canada) media in the presence of growth factors and CFU-Megakaryocyte(CFU-Mk) colonies were counted on day 12. The expansion of CD34+ and CD41+ cell was analyzed by flow cytometry after 5 days incubation using flask culture. RESULTS: The numbers of CFU-Mk colonies of mononuclear cells obtained from fetal liver in the 11th week gestational age were more than those in the 19th week specimens; growth factors could not enhance the colony expansion in all cases. Total numbers of CFU-Mk colony of fetal liver cells were higher than bone marrow from ITP or pancytopenia groups. The numbers of pure or large CFU-Mk colonies of fetal liver cells were also higher than bone marrow specimens. The rate of CD34+ cell expression of fetal liver was increased after flask culture and the enhancement effect of epression was seen only in cases which added thrombopoietin. The rate of CD41+ cell expression of fetal liver was increased after incubation, but the enhancement effect of growth factors was unclear. CONCLUSION: This study revealed good results about the megakaryocyte colony assay of fetal liver mononuclear cells using MegaCultTM-C media. This study suggests that the fetal liver could be a good source of megakaryocytic progenitor cells for clinical application in hematopoietic stem cell transplantation.
Bone Marrow ; Flow Cytometry ; Gestational Age ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Intercellular Signaling Peptides and Proteins ; Liver* ; Megakaryocytes* ; Pancytopenia ; Stem Cells ; Thrombopoietin

A retrospective analysis of brain metastasis with respect to the pathology, hydrocephalus, cause of death, survival time and therapeutic modality was carried out in 47 cases. The duration of survival after CNS metastasis far less depends on the primary tumor than the latent interval between the onset of first symptom from primary tumor and CNS metastasis dose. And death was attributable to the CNS metastases in at least 5.3% of these cases. Surgery and radiotherapy but chemotherapy were included in this study. Radiotherapy had significant effects on prolongation of survival. The surgery plus postoperative whole brain radiotherapy had the longest survivals than the other treatment modalities. The authors recommend guidelines for surgical resection, usually followed by radiotherapy:in cases which have good general condition enough to tolerate general anesthesia without any acute general morbidness, (1) single surgically accessible brain metastasis, (2) an incapacitating or large metastasis even when the tumor is not solitary, (3) uncertain primary cancer, (4) posterior fossa, especially cerebellar hemispheric metastasis. It seems that the presence of metastasis else where in the body should not exclude the case as a surgical candidate.
Anesthesia, General ; Brain* ; Cause of Death ; Drug Therapy ; Hydrocephalus ; Neoplasm Metastasis* ; Pathology ; Prognosis* ; Radiotherapy ; Retrospective Studies*

A retrospective analysis of brain metastasis with respect to the pathology, hydrocephalus, cause of death, survival time and therapeutic modality was carried out in 47 cases. The duration of survival after CNS metastasis far less depends on the primary tumor than the latent interval between the onset of first symptom from primary tumor and CNS metastasis dose. And death was attributable to the CNS metastases in at least 5.3% of these cases. Surgery and radiotherapy but chemotherapy were included in this study. Radiotherapy had significant effects on prolongation of survival. The surgery plus postoperative whole brain radiotherapy had the longest survivals than the other treatment modalities. The authors recommend guidelines for surgical resection, usually followed by radiotherapy:in cases which have good general condition enough to tolerate general anesthesia without any acute general morbidness, (1) single surgically accessible brain metastasis, (2) an incapacitating or large metastasis even when the tumor is not solitary, (3) uncertain primary cancer, (4) posterior fossa, especially cerebellar hemispheric metastasis. It seems that the presence of metastasis else where in the body should not exclude the case as a surgical candidate.
Anesthesia, General ; Brain* ; Cause of Death ; Drug Therapy ; Hydrocephalus ; Neoplasm Metastasis* ; Pathology ; Prognosis* ; Radiotherapy ; Retrospective Studies*

The authors ahve analyzed various chemical components of intracerebral hematoma in 20 cerebrovascular accident patients who were operated at the Department of Neurosurgery, Kosin Medical Center, from October, 1984 to April, 1986. The results showed that there are no differences between the levels of sodium and chloride in serum and hematoma, while potassium and phosphorus significantly higher in hematoma, and calcium lower in hematoma. The changes of various chemical components seem not to be correlated with the timing of operation. We are going to discuss the possible explanations of the changes.
Calcium ; Hematoma* ; Humans ; Neurosurgery ; Phosphorus ; Potassium ; Sodium ; Stroke

We report a rare case of tension pneumocephalus after eyebrow surgery for the treatment of a saccular aneurysm at posterior communicating artery. The patient's consciousness was suddenly aggravated due to the tension pneumocephalus on fifth postoperative day, which was treated by repairing the frontal sinus. The patient was recovered completely and uneventfully after this revision surgery.
Aneurysm* ; Arteries ; Consciousness ; Eyebrows* ; Frontal Sinus ; Humans ; Pneumocephalus*

A 41-yr-old man was admitted with acute headache, neck stiffness, and febrile sensation. Cerebrospinal fluid examination showed pleocytosis, an increased protein level and, a decreased glucose concentration. No organisms were observed on a culture study. An imaging study revealed pituitary macroadenoma with hemorrhage. On the 7th day of the attack, confusion, dysarthria, and right-sided facial paralysis and hemiparesis were noted. Cerebral infarction on the left basal ganglia was confirmed. Neurologic deficits gradually improved after removal of the tumor by endoscopic transnasal transsphenoidal approach. It is likely that the pituitary apoplexy, aseptic chemical meningitis, and cerebral infarction are associated with each other. This rare case can serve as a prime example to clarify the chemical characteristics of pituitary apoplexy.
Adenoma/*complications ; Adult ; Cerebral Infarction/*etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Meningitis/*etiology ; Pituitary Apoplexy/*complications/etiology ; Pituitary Neoplasms/*complications ; Tomography, X-Ray Computed

Vancomycin-resistant enterococci(VRE) are rare cause of meningitis, occurring in immunocompromised patients, severely ill, hospitalized patient, and patients who have undergone neurosurgical procedures. Resistance to vancomycin has increased in frequency during the past few years. Limited therapeutic options are available for VRE infections and the optimum therapy has not been established. We report a case of VRE meningitis that was successfully treated with administration of quinupristindalfopristin (Synercid) by both intravenous and intraventricular routes. A brief review of the literature is provided, which indicates that optimal management with Synercid should include daily intraventricular doses of at least 2 mg and intravenous 0.5 mg/kg every 8 hours. We also review the previously reported cases of VRE meningitis.
Enterococcus* ; Humans ; Immunocompromised Host ; Meningitis* ; Neurosurgical Procedures ; Vancomycin

OBJECTIVE: This study is aimed to assess the clinical outcome in early and minimally invasive surgery using an eyebrow incision for the patients with poor grade aneurysm. METHODS: The authors retrospectively reviewed all 46 poor grade patients of Hunt and Hess(H-H) grade IV and V who suffered aneurysmal subarachnoid hemorrhage(SAH) between 1999 and 2004. All 35 patients harboring 43 aneurysms who underwent early surgery within 72 hours were included in this study. Clinical outcome was assessed by Glasgow outcome scale(GOS) and compared with that of conventional pterional approach. RESULTS: Twenty four patients were operated with conventional pterional approach and 11 with eyebrow approach within 72 hours after SAH. Seven multiple aneurysm patients harbor 15 aneurysms. Forty one aneurysms were treated with clippings. All 11 patients of eyebrow surgery group(ESG) were in H-H grade IV, 3 in Fisher grade III and 8 in Fisher grade IV. Among 24 patients of pterional approach group(PAG), 20 were in H-H grade IV and 4 in H-H grade V, 3 were in Fisher grade III and 21 in Fisher grade IV. Overall favorable outcome was achieved in 41.7% and 54.5% in PAG and ESG, respectively. Favorable outcome of H-H grade IV in PAG showed 45.0%. Overall mortality rate was 14.3%. CONCLUSION: It is concluded that the clinical outcome of early and minimally invasive aneurysmal surgery using eyebrow incision in the selected poor grade aneurysm patients can be compatible with that of conventional pterional surgery.
Aneurysm* ; Eyebrows* ; Humans ; Mortality ; Retrospective Studies ; Surgical Procedures, Minimally Invasive