Disseminated intravascular coagulation (DIC) is a pathological syndrome in which activation of coagulation cascade leads to fibrin clot formation, consumption of platelets and coagulation factors, and secondary fibrinolysis. We report a case of severe postoperative hemorrhagic diathesis due to DIC. A 59-year-old man was scheduled for reduction of tibia fracture and anatrophic nephrolithotomy of staghorn calculi. On the fifth postoperative day, second operation was performed for nephrectomy due to perirenal hematoma. Two days later, third operation was performed for hemostasis because of the continuous bleeding. Coagulation tests showed positive DIC profiles of thrombocytopenia, hypofibrinogenemia, increased fibrin degradation products, and prolonged prothrombin time and thrombin time. The patient recovered uneventfully and discharged on the 59th postoperative day.
Blood Coagulation Factors ; Calculi ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Fibrin ; Fibrin Fibrinogen Degradation Products ; Fibrinolysis ; Hematoma ; Hemorrhage* ; Hemorrhagic Disorders ; Hemostasis ; Humans ; Middle Aged ; Nephrectomy ; Postoperative Complications ; Prothrombin Time ; Thrombin Time ; Thrombocytopenia ; Tibia

Injuries to the extensor mechanism include a wide range of injuries from minor one to massive defect. And the methods of treatment must be individualized according to the anatomical site, extent and chronicity of injuries. The extensor mechanism is a triangular thin sheet like structure, the function of which cannot be explained completely by the Tubiana's church-steeple like diagram. Authors think that the extensor mechanism should be repaired or reconstructed as a triangular sheet. The tension of the repaired or reconstructed tendon was estimated as good when the neutral extensions were obtained in all the MP, PIP and DIP joints after the completion of sutures. Also authors think that stable sutures are mandatory for the early rehabilitation postopoeratively. Seventy-five patients have been treated by the authors from 1982 to 1994. According to zonal classification, forty-two patients were injured in Zone I. 5 in Zone II, 21 in Zone III, 5 in Zone IV and 2 patients were unclassified due to massive defects of the extensor mechanism. Mostly bony mallet injuries were treated by open reduction and K-wire fixation. Acute tendinous mallet injuries were treated by conservative splinting and old injuries were treated by anatomical plication of the terminal extensor tendon. Old buttonhole deformities were generally treated by the central tendon plication. Massive defects were managed by skin coverage and reconstruction of the extensor mechanism by using a tendon graft which was tailored like a triangular thin sheet. With author's treatment principles, excellent or good results were obtained in about 87%. Consequently, authors emphasize that an anatomical repair or reconstruction is a keystone in the treatment of injuries to the extensor mechanism.
Classification ; Congenital Abnormalities ; Fingers ; Fluconazole ; Humans ; Joints ; Rehabilitation ; Skin ; Splints ; Sutures ; Tendons ; Transplants

No abstract available.
Extremities*

No abstract available.
Catheterization* ; Catheters* ; Hemothorax* ; Subclavian Vein*

No abstract available.
Thyroid Gland* ; Thyroid Nodule*

No abstract available.

OBJECTIVES: The early detection of ectopic tubal pregnancy in unruptured state is increased as the transvaginal sonography and sensitive serum hCG test are available. For this unruptured tubal pregnancy, the medical treatment using methotrexate via various routes and dosage is being tried. Our study was to evaluate the efficacy of single systemic injection of methotrexate in the treatment of unruptured tubal pregnancies. Material and METHODS: From the January 1997 to July 1999, of 152 ectopic pregnancy patients, 22 patients who were diagnosed as unruptured tubal pregnancies were treated with single-dose systemic methotrexate injection (50 mg/m2/IM). Exclusion criteria were unstable vital signs with hemoperitoneum, adnexal mass > 5-6 cm. Serum hCG titers were checked before injection and 4, 7 day after injection. If serum hCG titer declined more than 15% on 7 day after injection compared with titer on 4 day, the weekly hCG titer was followed until it was <10 mIU/ml .If the hCG titer did not decline more than 15 %, a second dose was given. If hCG titer was not decreased or vital signs became unstable after 1-2 injections, the treatment was considered failure and surgery was done. RESULTS: 18 cases (82%) of 22 were successfully treated with single-dose methotrexate. The mean size of ectopic mass and initial serum hCG titers were 2.7+/-1.3 cm (range, 1.5-5.4 cm) and 3,298+/-1,007 mIU/ml (range, 132-12,239), respectively. Of 22, 6 cases (28%) needed second dose of methotrexate. The mean time to resolution of serum beta-hCG titer was 27.5+/-13.6 days (range, 8-53 days). Elevation of liver enzyme did not occurred in all cases during treatment. Initial hCG titer was more important prognostic factor than ectopic mass size for successful medical treatment. CONCLUSION: Single-dose methotrexate appears to be an effective medical treatment for the unruptured tubal pregnancy. However, patients selection using strict criteria is needed to increase its success rate.
Female ; Hemoperitoneum ; Humans ; Liver ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Vital Signs

Construction of an obturator for rehabilitation of a patient who underwent a maxillectomy is vital. Routinely a constructed obturator includes denture portion. A patient who may present anatomical limitations due to surgical or radiotherapy complications often challenges the clinician. Purpose: This clinical report describes a patient with severe trismus after surgical resection and radiotherapy treatment of a tumor in the upper left maxilla. Conclusion: This report describes the concepts of using a rotational path insertion for an obturator and a separately constructed maxillary denture. The stability and retention of the obturator were obtained from anatomical features. Where as these were achieved through magnetic attachments and the remaining edentulous ridge to ensure esthetic and function of the prosthesis.
Dentures ; Dietary Sucrose ; Humans ; Magnetics ; Magnets ; Maxilla ; Prostheses and Implants ; Retention (Psychology) ; Trismus

Even though there are diverse tumors invading skull base, it is impossible to completely remove the tumor only by transcranial approach due to its anatomical complexity. Therefore we operated by transfacial approach as well which allows to have a good vision and remove the tumor from different directions. Transfacial approach is to approach tp the skull base for the tumor located on the margin of skull and face through exposing such as nasal cavity, paranasal cavity, nasopharyngeal cavity, etc. after separating facial bone. In 1990 Janecka introduced it, dividing the face into 4 groups: mini, standard, expanded, and bilateral facial translocation, based on neurovascular and aesthetic line. Transfacial approach makes it possible to do three dimensional tumor resection, remove the tumor, check its margin directly, and have functionally and aesthetically satisfactory reconstruction. In such cases that tumor invades lower part of skull base, the tumor can be removed only by transcanial approach. Although tumor can be removed by transcranial approach to find the location three dimensionally, transfacial approach can be used as adjunctive means which allow to get a good vision and remove the remnant completely. For 36 months, we have executed 16 cases of tranfacial approach, removing tumors located at the skull base. We classify and suggest the role of tranfacial approach based on our documents.
Facial Bones ; Nasal Cavity ; Skull Base* ; Skull*

Many craniofacial and neurosurgical procedures rely on cranial bone as a bone graft. In the majority of instances, the bone heals and gives good results. But we found that if either the dura or the pericranium were missing adjacent to the cranial bone, bone absorption would be increased. We studied a single animal model, investigating the contribution of the dura and the pericranium in the process of cranial bone absorption. The animals were divided into four groups of each five animals depending on the differential blockade of the dura and/or the pericranium by silastic sheet. Bilateral 100-mm2, parietal bone flaps were harvested from mature rabbits. Animals were humanely killed after 12 weeks, and histomorphometric analysis was performed. The volume maintenance is as follows; Group I; 89.0%, Group II; 80.0%, Group III; 63.3%, Group IV; 52.4%. The weight maintenance; Group I; 87.1%, Group II; 79.4%, Group III; 61.6%, Group IV; 51.1%. The histological contribution of living bone; Group I; 92.9%, Group II; 85.6%, Group III; 71.1%, Group IV; 56.2%. Significantly increased bone absorption occurred in Group II, III, IV compared with Group I. Conclusions are: 1. Cranial bone absorption is effected by both the dura and the pericranium. 2. The dura is more important than the pericranium in preventing cranial bone absorption. 3. The dura to be the source of central cranial bone and the pericranium to be the source of peripheral cranial bone.
Absorption* ; Animals ; Humans ; Models, Animal ; Neurosurgical Procedures ; Parietal Bone ; Rabbits ; Transplants