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

BACKGROUND: Diclofenac is a nonsteroidal anti-inflammatory drug widely used as adjuvants for postoperative pain management with opioid sparing effect. The effect of diclofenac on postoperative opioid analgesia of morphine and meperidine was evaluated in 180 women after cesarean section. METHODS: One hundred eighty parturients were randomly allocated to four groups and each group had 45 women. The parturients were given loading dose of morphine in M group and meperidine in D group using intravenous patient controlled analgesia (PCA) device for up to 48 hours when the parturients awoke and complained abdominal pain. The parturients received diclofenac 75 mg every 12 hours intramuscularly followed by loading dose of morphine in MV group and meperidine in DV group. We evaluated the postoperative opioid requirement, numerical rating pain score, delivery/demand ratio, patient's satisfaction and side effects including respiratory depression, itching, nausea, urinary retention and dizziness. RESULTS: Diclofenac decreased over 40% of morphine or meperidine requirement and also pain score at 1, 2, 3, 6, 12, 24 and 48 hours in the use of PCA morphine and at 6, 12 and 24 hours in the use of PCA meperidine. And the incidence of sedation and itching decreased in MV and DV group. CONCLUSION: We concluded that diclofenac as adjuvant of opioid for postoperative pain after cesarean section could decrease requirement of morphine and meperidine, increase pain relief and decrease sedation and itching.
Abdominal Pain ; Analgesia ; Analgesia, Patient-Controlled ; Cesarean Section* ; Diclofenac* ; Dizziness ; Female ; Humans ; Incidence ; Meperidine* ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis* ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Urinary Retention

PURPOSE: To evaluate the changes and normal ranges of the artery-bronchus ratio (ABR) during respiration MATERIALS AND METHODS: We analyzed HRCT of 10 healthy adults. The HRCT findings of ten healthy adults were analysed. CT scanning was performed with 1 mm collimation at 3 mm intervals during full inspiration and full expiration, with a range during inspiration from 2 cm to 4 cm above the carina and from 4 cm above to 2 cm below the right hemidiaphragm. The range during expiration was from 1 cm to 3 cm above the carina and from 4 cm above to 2 cm below the right hemidiaphragm. ABiR (defined as the diameter of pulmonary artery divided by the inner diameter of the bronchus), ABoR (defined as the diameter of pulmonary artery divided by the outer diameter of the bronchus) and BLR (defined as the inner diameter of the bronchus divided by the outer diameter of the bronchus) were measured on the display console. RESULTS: The mean inner diameter of the bronchi was 2.04+/-0.73 mm during inspiration and 1.68+/-0.51 mm during expiration, while the mean diameter of the arteries was 3.95+/-1.03 mm during inspiration and 4.37+/-1.09 mm during expiration. The diameters of the bronchi were thus seen to increase during inspiration, and the diameters of the pulmonary arteries, to decrease. The mean thickness of the bronchial wall was 1.07+/-0.19 mm during inspiration and 1.06+/-0.24mm during expiration; thus, no change in thickness was seen during respiration (p<0.05). Mean ABiR was 2.01+/-0.60 (range 1.15-4.58) during inspiration and 2.59+/-0.74(range 1.16-4.9) during expiration, and in all cases the inner diameter of the bronchus was less than that of the accompanying pulmonary artery. Mean ABoR was 0.91+/-0.19 during inspiration and 1.09+/-0.22 during expiration. while for BLR, the corresponding fingures were 0.46+/-0.06, and 0.44+/-0.09. CONCLUSION: HRCT is a useful tool for evaluating changes in the pulmonary arteries and bronchi during respiration.
Adult ; Arteries ; Bronchi ; Humans ; Pulmonary Artery ; Reference Values ; Respiration* ; Tomography, X-Ray Computed

The purpose of this study was to investigate the anatomic and functional changes of submucous cleft palate operated with Furlow palatoplasty. A total of 36 patients with submucous cleft palate underwent Furlow palatoplasty from 1993 to 1998. The mean follow-up period was 5 years 3 months. Midfacial growth was measured using lateral cephalograms in 18 patients, whose age was older than 8 years of age. Speech analyses were performed in 25 patients by the same speech pathologist for the degrees of nasality and articulation. The parameters obtained in the lateral cephalogram were compared with a healthy population in Korea. ANS-PNS was in 61.1% within the clinical normal range for the age group. SNA and SNB were in 55.6% within the normal range. ANB was in 72.2% and Ba-PNS was 50.0% within the range. The postoperative nasality scores of open vowels and round vowels were 24.2% and 25.2%, respectively, which were lower than preoperative scores. The mean articulation accuracy value was 92.9% which was higher than preoperative value. Our results suggest that Furlow palatoplasty is a useful procedure as the initial treatment of the submucous cleft palate and has the advantages in both aspects of speech results and facial growth.
Cleft Palate* ; Follow-Up Studies ; Humans ; Korea ; Reference Values

BACKGROUND: The causes of hepatic dysfunction after exposures to the halogenated inhaled anesthetics may be free radical, metabolites of inhaled anesthetics, immune reaction and hypoxic damage by decreasing total hepatic blood flow. The present study was performed to comparison of estimated hepatic blood flow and systemic hemodynamic changes between the general anesthesia with enflurane and thoracic epidural anesthesia in rabbits. METHODS: In general anesthesia group with enflurane, anesthesia was performed with enflurane 2vol% and 100% oxygen for 60 minutes. In thoracic epidural anesthesia group, epidural block was done at T5 level with 0.4 ml/kg of 1% lidocaine. Hepatic blood flow was estimated by clearance of indocyanine green according to the constant infusion method before and 30, 60 minutes after anesthesia. Heart rate, mean arterial pressure, central venous pressure and splanchnic vascular resistance were measured at the same time in both groups. RESULTS: Heart rate was decreased significantly in thoracic epidural anesthesia group and mean arterial pressure and central venous pressure were decreased significantly in both groups at 30, 60 minutes. Hepatic blood flow was decreased at 30, 60 minutes in both groups. Splanchnic vascular resistance was increased significantly 30, 60 minutes in thoracic epidural anesthesia group. There were significant differences in mean arterial pressure and splanchnic vascular resistance between two groups. There was no difference in hepatic blood flow between two groups. CONCLUSIONS: The decreased hepatic blood flow was caused by decreased mean arterial pressure in general anesthesia group with enflurane and by increased splanchnic vascular resistance in thoracic epidural anesthesia group.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; Arterial Pressure ; Central Venous Pressure ; Enflurane ; Heart Rate ; Hemodynamics* ; Indocyanine Green ; Lidocaine ; Oxygen ; Rabbits ; Vascular Resistance

The acquisition of human chondrocytes for transplantation and cartilage coverage presents a major problem as these cells dedifferentiate rapidly during expansion in monolayer culture. Dedifferentiated chondrocytes change their shapes, metabolic states, and programs of matrix biosynthesis. We initiated this study on the basis of the hypothesis that bFGF, VEGF, and micromass culture can influence both the proliferation and their ability to express COL2A1 gene as a chondrogenic marker and Cbfa1 gene as an osteogenic marker. Chondrocytes in monolayer and micromass culture with or without bFGF and VEGF in vitro were collected and analyzed. In results, bFGF stimulated the proliferation of chondrocytes in monolayer culture. VEGF also stimulated the proliferation, but was less effective. The phenotype of chondrocytes was gradually changed in monolayer culture. Chondrocytes expanded in the presence of bFGF became dedifferentiated. However, dedifferentiated chondrocytes fully maintained their potential for redifferentiation in response to environmental changes. After transferring in micromass culture, chondrocytes which expanded with bFGF demonstrated high COL2A1 expression that was biochemically comparable to primary chondrocytes. Chondrocytes which expanded with VEGF demonstrated high Cbfa1 expression in both monolayer and micromass culture with passage times. This study provides that bFGF is needed to expand chondrocytes during tissue cultivation and additional three-dimensional environment is needed to maintain their differentiated phenotype. VEGF initiates the osteogenic potential during the chondrocyte expansion especially in micromass culture.
Cartilage ; Chondrocytes* ; Humans* ; Phenotype ; Vascular Endothelial Growth Factor A*

Extensive and complicated defects on the body call for an omnipotent tool for a perfect reconstruction. Flaps derived from the omentum has many advantages over the conventional flaps. From 1999 to 2004, Omental flaps were applied for various soft tissue reconstructions. Among total 20 total 7 cases were for immediate reconstruction, 2 cases for chronic infection, 3 cases for simultaneous reconstruction of two defects, 4 cases for functional joint reconstruction and 4 cases were for flow- through revascularization. Among these cases, 3 cases were operated with minimal incision harvest technique. There were no complete flap failures, partial necrosis of the distal parts were noted on three cases. The omental flap is indicated on a large contaminated defect reconstruction due to its large size, well-vascularized, and malleable properties. The omental flap provides several additional advantages over other flaps, which are; the availability of the one staged simultaneous reconstruction of two defects with one flap, providing gliding function for the joint motion, and a flow-through characteristics with long vascular pedicle. But there are some serious shortcomings, including a long abdominal scar and intraabdominal problems. However, these are rare and can be minimized with our minimal incision technique. Due to its unique characteristics. the omentum is one of the ideal tissues for the reconstruction of the complicated soft tissue defects due to its unique characteristics.
Cicatrix ; Joints ; Necrosis ; Omentum

Primary mucinous eccrine carcinoma(MEC) of the skin, one of sweat gland tumor, is a rare. These tumors usually occur in one's fifties and seventies, and are characterized by the secretion of mucin that usually forms the pools surrounding the clusters of tumor cells. The common sites are the eyelids and medial canthus. Pathologically it is difficult to distinguish between primary mucionus carcinoma and metastatic cancers from breast, rectum, colon, bronchus, kidney, ovary, stomach, lacrimal glands, salivary glands, and paranasal sinuses. Therefore study for primary focus is needed. A 62-year-old mand has had a mass on left lower eyelid skin without palpable neck lymph nodes for about five years. In a fine needle aspiration, there were tumor cells floating in a mucin pool. The authors examined several tests including complete blood cell count, liver function test, renal function test, urinalysis, electrocardiography, VDRL, TPHA-S, chest X-ray, chest computed tomography(CT), neck CT, abdominopelvic CT, etc. All the tests showed the origin was the skin. It is diagnosed to primary MEC on skin. The tumor was treated by wide excision with 0.5cm in safe margin and full thickness skin graft was done. There has been no recurrence 10 months after operation.
Biopsy, Fine-Needle ; Blood Cell Count ; Breast ; Bronchi ; Colon ; Electrocardiography ; Eyelids* ; Female ; Humans ; Kidney ; Lacrimal Apparatus ; Liver Function Tests ; Lymph Nodes ; Middle Aged ; Mucins* ; Neck ; Ovary ; Paranasal Sinuses ; Rectum ; Recurrence ; Salivary Glands ; Skin* ; Stomach ; Sweat Glands ; Thorax ; Transplants ; Urinalysis

The immune system is specifically sensitive to oxidative stress induced by ionizing radiation because of its rapid proliferative activity. For this reason, an instructive immune system is one of the best ways to minimize side effects, such immunodeficiency, of gamma radiation. Over the past few decades, several natural plants with antioxidant and immunomodulatory properties have been identified as adjuncts for nontoxic and successful radiotherapy. Hizikia fusiforme extract (HFE) containing plentiful dietary fiber and fucoidan is known for its instructive antioxidant capacity, immunomodulation abilities, and immune activation. In this study, we determined whether HFE protects radiosensitive immune cells from gamma radiation-induced damage. C57BL/6 mice were irradiated with gamma-ray. The effect of HFE on the ionizing radiation damage of immune cells was then evaluated with an MTT assay, 3H-thymidine incorporation assay, and PI staining. We found that HFE stimulated the proliferation of gamma-ray irradiated immune cells without cytotoxic effects. We also observed that HFE not only decreased DNA damage but also reduced gamma radiation-induced apoptosis of the immune cells. Our results suggest that HFE can protect immune cells from gamma-ray damage and may serve as an effective, non-toxic radioprotective agent.
Animals ; Apoptosis ; Dietary Fiber ; DNA Damage ; Gamma Rays ; Immune System ; Immunomodulation ; Mice ; Oxidative Stress ; Radiation, Ionizing ; Radiotherapy

Background: Esophageal variceal hemorrhage is the most life threatening complication of portal hypertension secondary to chronic progressive liver disease such as liver cirrhosis. Recently, endoscopic injection sclerotherapy(EIS) and endoscopic variceal ligation(EVL) have been known to be the most effective, simple and safe methods. Gastric varices are sometimes associated with esophageal varices in patients with portal hypertension. However the role of endoscopic sclerotherapy in the treatment of gastric varices has not been adequately evaluated, and the fate of coexisting gastric varices after eradication of esophageal varices is not clearly known. Methods: EIS or EVL was preformed in 174 patients with variceal hemorrhage in CHUNG-NAM NATIONAL UNIVERSITY HOSPITAL from September 1990 to December 1993. Among the total 174 patients, 50 patients were followed for at least 1 year. Forty four patients were treated with EIS, and 6 witb EVL. We assesed the influence of EIS or EVL on coexisting gastric varices and the development of gastric varices after EIS or EVL in 50 patients.
Equidae ; Esophageal and Gastric Varices* ; Hemorrhage* ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Diseases ; Sclerotherapy