No abstract available.
Calcium Pyrophosphate* ; Calcium* ; Elbow*

BACKGROUND: Endotoxin stimulates nitric oxide synthase (NOS) and the free radical nitric oxide (NO) is produced by NOS, which vasodilates the smooth muscle of pulmonary vessels. Otherwise, endotoxemia stimulates the release of cyclooxygenase (COX) products, which may modify hypoxic pulmonary vasoconstriction (HPV). We also observed the effect of nonselective NOS inhibition by NG-nitro-L-arginine methyl ester (L-NAME) on receptor-mediated acetylcholine (Ach)/bradykinin (BK) induced vasoconstriction and receptor independent HPV in E.coli lipopolysaccharide (LPS) induced septic isolated rat lungs. METHODS: Four hours before surgical instrumentation for lung isolation, we administered saline (1 ml) to the control group (n = 15), E.coli LPS (20 mg/kg) to the LPS group (n = 14) and LPS (30 mg/kg) the nitric oxide synthase inhibitor, L-NAME (15 mg/kg) to the LPS + L-NAME group (n = 14), intraperitoneally. In 43 isolated rat lungs perfused with physiologic salt-albumin- blood mixture, angiotensin II 0.2 microgram was injected into the perfusion circuit, to confirm pulmonary vascular reactivity in each isolated lung. HPV responses were induced by three hypoxic challenges for 5 minutes separated by 5 minutes of ventilation with a normoxic gas mixture. We observed the pulmonary arterial pressure at each challenge, ten minutes after the last HPV, 0.01, 0.1, 1.0 microgram of Ach and 1, 3, 10 microgram of BK were injected. PAP and static lung compliance were measured. RESULTS: The baseline pulmonary artery pressure in the LPS group higher than in the controls and HPV in the LPS group was changed compared to the controls but in the LPS + L-NAME it was higher than in the controls. The administration of Ach 0.1, 1.0 microgram and BK 3, 10 microgram causedpulmonary vasoconstriction and the vasoconstrictions of BK were dosage-dependent. Lung stiffness in the LPS and LPS + L-NAME groups were higher than those of the controls. CONCLUSIONS: Vascular constriction of pulmonary vessels and increased lung stiffness by Ach and BK might be the result of the endothelial injury. But pulmonary vasoconstriction and stiffness by Ach and BK were similar in the LPS and LPS + L-NAME groups, showing that factors other rather than excessive NO production might be involved in endothelial injury.
Acetylcholine ; Angiotensin II ; Animals ; Arterial Pressure ; Constriction ; Endotoxemia ; Lung Compliance ; Lung* ; Muscle, Smooth ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Perfusion ; Prostaglandin-Endoperoxide Synthases ; Pulmonary Artery ; Rats* ; Surgical Instruments ; Vasoconstriction* ; Ventilation

Cyclopia is rare congenital craniofacial anomaly, in which the eyes are fused together and located in a single orbit. It is consistently associated with severe holoprosencephaly, which is the failure of cleavage of the prosencephalon with a deficit in the midline facial development. chromosomal study revealed 47, X( ), +13 (Patau syndrome).
Holoprosencephaly ; Orbit ; Prosencephalon ; Trisomy*

BACKGROUND: Most breast carcinomas are easily categorized as ductal or lobular. However, in some cases the distinction can be difficult since some tumors may have intermediate features of these two. Prior studies suggest that E-cadherin is useful to classify tumors as ductal or lobular, as it is lost in lobular but not in ductal carcinomas. METHODS: We studied the histologic features and E-cadherin expression by immunohistochemistry in 57 cases of breast carcinomas, which were divided into three groups based on histology. Group 1 included 4 cases of infiltrating lobular carcinoma (IFL) and 1 case of lobular carcinoma in situ (LCIS) (n=5). Group 2 included infiltrating ductal carcinoma (IFD) with some features of IFL (n=48). Group 3 included a solid type of intraductal carcinoma (DCIS) (n=4). E-cadherin staining was scored as negative or positive. RESULTS: All 5 cases from group 1 were E-cadherin negative, and all 4 DCIS cases were positive. Only 2 (0.04%) of the 48 cases from group 2 were E-cadherin negative. CONCLUSIONS: Our findings suggest that the majority of cases with morphologically IFD with some IFL features are ductal. E-cadherin immunostaining is of value in helping to characterize breast carcinomas with indeterminate morphologic features.
Breast Neoplasms ; Breast* ; Cadherins* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular* ; Immunohistochemistry

Cutaneous squamous cell carcinoma (SCC) is the second most common skin malignancy. This report describes the case of an unusual extensive SCC involving the whole hemiface, which required reconstruction with a combination of a dual vascular free transverse rectus abdominis muscle (TRAM) flap and a skin graft. A 79-year-old woman visited our hospital with multiple large ulcerated erythematous patches on her right hemiface, including the parieto-temporal scalp, bulbar and palpebral conjunctiva, cheek, and lip. A preliminary multifocal biopsy was performed in order to determine the resection margin, and the lesion was resected en bloc. Orbital exenteration was also performed. A free TRAM flap was harvested with preserved bilateral pedicles and was anastomosed with a single superior thyroidal vessel. The entire TRAM flap survived. The final pathological examination of the resected specimen confirmed that there was no regional nodal metastasis, perineural invasion, or lymphovascular involvement. The patient was observed for 6 months, and there was no evidence of local recurrence. Usage of a TRAM flap is appropriate for hemifacial reconstruction because the skin of the abdomen matches the color and pliability of the face. Furthermore, we found that the independent attachment of two extra-flap anastomoses to a single recipient vessel can safely result in survival of the flap.

Prolonged soft tissue compression results in discomfort and pain secondary to local ischemia in normal individuals. During surgery, patients are immobile and unable to perceive the discomfort of prolonged pressure, and the anesthetized patient lacks a protective mechanism to prevent pressure sores. Many intrinsic and extrinsic factors are associated with pressure sore development; however, the intensity and duration of pressure are critical components in the etiology of pressure sores. We conclude that interface pressure on a patient lying on an operating table during a long operation is a primary factor of postoperative occipital pressure sores.
Deception ; Humans ; Ischemia ; Operating Tables ; Pressure Ulcer*

BACKGROUND: The objectives of the study were to determine how gas exchanges indices including alveolar-arterial oxygen tension difference(A-aDO2), PaO2/PAO2, PaO2/FIO2 and pulmonary shunt ratio (QS/QT) were changed after open heart surgery according to the change of inspired fraction of oxygen(FIO2) and to identify the reliable parameters for postoperative respiratory care in the intensive care unit. METHODS: Blood gases were measured from radial and pulmonary arterial blood for arterial and mixed venous blood in 15 patients, with a mean age of 45.1 yr, after open heart surgery, in mechanically ventilated states with 1.0, 0.6 and 0.4 of FIO2 with normocarbia maintained (PaCO2 30~40 mmHg). Above mentioned gas exchange indices were calculated and compared. RESULTS: After decreasing the FIO2 from 1.0 to 0.6 and 0.4 in order, the major changes were significant decrease in pulmonary shunt ratio : 24+/-3%, 17+/-3% and 11+/-3% at FIO2 1.0, 0.6 and 0.4, respectively and A-aDO2 : 347+/-34 mmHg, 184+/-16 mmHg and 94+/-11 mmHg at FIO2 1.0, 0.6 and 0.4 respectively, while PaO2/PAO2 showed the only significant increase at FIO2 0.4 compared with those at FIO2 1.0 and PaO2/FIO2 was unchanged. CONCLUSIONS: In cases of open heart surgical patient with cardiovascular stability, pulmonary shunt ratio and A-aDO2 appear to be more sensitive on gas exchange, but the oxygen tension indices such as PaO2/PAO2 as well as PaO2/FIO2 might be suggested as possible alternatives for the shunt measurement.
Gases ; Heart* ; Humans ; Intensive Care Units ; Oxygen ; Thoracic Surgery*

Mandibular defects lead to severe deformation and functional deficiency. Vascularized osteocutaneous tissue has been widely used to reconstruct the mandible. However, it is technically challenging to shape this type of grafts in such a manner that they resemble the configuration of the mandible. A 48-year-old female patient who underwent anterolateral thigh (ALT) flap coverage after a tongue cancer excision was diagnosed with a tumor recurrence during the follow-up. A wide excision mandibulectomy and mandibular reconstruction with an ALT flap and a titanium implant were performed. The prefabricated titanium implant was fixed to the condyle. Then, an ALT flap was harvested from the ipsilateral thigh and anastomosed. After confirming that the circulation of the flap was intact, the implant was fixed to the parasymphysis. On the radiograph taken after the surgery, the prosthesis was well positioned and overall facial shape was acceptable. There was no postoperative complication during the follow-up period, 1 year and 2 months. The prefabricated implant allows the restoration of facial symmetry without harvesting autologous bone and it is a safe and effective surgical option for mandibular reconstruction.
Female ; Follow-Up Studies ; Humans ; Mandible ; Mandibular Prosthesis Implantation ; Mandibular Reconstruction* ; Middle Aged ; Postoperative Complications ; Prostheses and Implants ; Recurrence ; Thigh ; Titanium* ; Tongue Neoplasms ; Transplants

Nipple size varies from person to person, but having a large nipple, or macrothelia, can be a concern for some women; therefore, some surgical methods have been developed for the reduction of nipple size. Conventional surgical methods for nipple reduction are classified into two types according to their purpose: reduction of length and reduction of diameter. For reduction of length, soft tissue is resected (except the central supplying vessel) and shortened by circumferential repair. The disadvantage of this method is possible necrosis of the nipple and impairment of the lactiferous duct. For reduction of diameter, a wedge-shaped resection is done from side to center and the defect is covered by a local advancement flap. The disadvantage of this method is the locally focused tension line, which is associated with unfavorable aesthetic outcomes. In this article, we present a case involving a novel method of nipple reduction surgery, referred to as the tripod wedge resection technique, which has three benefits compared to conventional nipple reduction surgery: simultaneous reduction of both length and diameter, relative safety for the vasculature and lactiferous duct, and an evenly tensioned incision line.

Nipple size varies from person to person, but having a large nipple, or macrothelia, can be a concern for some women; therefore, some surgical methods have been developed for the reduction of nipple size. Conventional surgical methods for nipple reduction are classified into two types according to their purpose: reduction of length and reduction of diameter. For reduction of length, soft tissue is resected (except the central supplying vessel) and shortened by circumferential repair. The disadvantage of this method is possible necrosis of the nipple and impairment of the lactiferous duct. For reduction of diameter, a wedge-shaped resection is done from side to center and the defect is covered by a local advancement flap. The disadvantage of this method is the locally focused tension line, which is associated with unfavorable aesthetic outcomes. In this article, we present a case involving a novel method of nipple reduction surgery, referred to as the tripod wedge resection technique, which has three benefits compared to conventional nipple reduction surgery: simultaneous reduction of both length and diameter, relative safety for the vasculature and lactiferous duct, and an evenly tensioned incision line.