It remains a problem that successful revascularization and reperfusion after ischemia are associated with high systemic complication rates and severe local tissue injuries. With prolonged ischemia, there is damage to tissue from anoxia, but further injury may occur after reperfusion. The activation of leukocytes and endothelial cells during reperfusion causes neutrophil adhesion in capillaries, resulting in plugging and further ischemia, Alternativety, neutrophil adhesion to endothelium leads to the migration of neutrophil with local edema formation, hemorrhage and thrombosis. Some chemotactic and activating factors are needed to propel neutrophils to the site of local inflammation. The chief cytikines that induce a pro-adhesive state in endothelium are tumor necrosis factor-alpha(TNF-alpha), interleukin-1 beta(IL-1 beta) and endotoxin or lipopolysaccharide(LPS). Similarly, TNF-alpha,and to a lesser extent interleukin-8(IL-8), is the important stimulus that acts on neutrophils and other leukocytes to alter their adhesion. The purpose of this study was to evaluate the pathogenetic role of IL-8 after perfusion with CDl8 monoclonal antibody(CDl8 mAb), the blocking antibody of neutrophil adherence, on reperfusion injury in rat epigastric island skin flap. A 6 X 3 cm-sized island skin flap was made on the abdomen. The epigastric pedicle was occluded for six hours with ambient temperature. Fifteen minutes before reperfusion, the flap was perfused with saline and CDl8 mAb(1 mg/kg). For evaluation of IL-8 levels, tissue fluid and serum were obtained at 4, 8, 12 and 24 hours after reperfusion. IL-8 concentrations of the CDl8 mAb group in the tissue fluid were significantly decreased at 8, 12 and 24 hours compared to the control group(P > 0.01), but the difference between the two groups was not significant at 4 hours after reperfusion IL-8 concentrations of the CDl8 mAb group in the serum were significantly decreased over time compared to the control group(P > 0.05, p > 0.01). Form the above results, we concluded that blocking neutrophil adherence using CD18 mAb within the peak level of IL-8 at 4 hours after reperfusion may be a better method of reducing reperfusion injury to the island skin flap.
Abdomen ; Animals ; Anoxia ; Capillaries ; Edema ; Endothelial Cells ; Endothelium ; Hemorrhage ; Inflammation ; Interleukin-1 ; Interleukin-8* ; Ischemia ; Leukocytes ; Necrosis ; Neutrophils ; Perfusion ; Rats ; Reperfusion Injury* ; Reperfusion* ; Skin ; Thrombosis

This study was carried out to provide some principles for the improvement of clinical training in medical students. To investigate the current problems in our systems of clinical training, we made sev eral questionnaires and distributed to the individuals of each survey groups. Senior medical students (59), interns (31), residents (14) and medical staffs (15) were included in these survey groups. The summarized current problems in clinical training are as follows : 1) lack of personnels in charge of clinical training, 2) lack of objective criteria for the evaluation of clinical training, 3) lack of involvement of students in clinical patient management, 4) needs of improvement in contents of clinical education, 5) lack of strict execution of education program, 6) lack of places for clinical education, 7) lack of interests in clinical training of the staffs, 8) needs of the orientation for the students about hospital systems. With this summary we held workshop for the staffs (29) in charge of clinical education. The summarized methods to improve clinical education were to promote interests in clinical education of staffs, to select the personnel in charge of clinical education, to make assignment of patient to the students, to let the student write patient progress note, to improve evaluation method for clinical education, to orient student about clinical education.
Education ; Humans ; Linear Energy Transfer ; Medical Staff ; Students, Medical* ; Surveys and Questionnaires

This study was carried out to provide some principles for the improvement of clinical training in medical students. To investigate the current problems in our systems of clinical training, we made sev eral questionnaires and distributed to the individuals of each survey groups. Senior medical students (59), interns (31), residents (14) and medical staffs (15) were included in these survey groups. The summarized current problems in clinical training are as follows : 1) lack of personnels in charge of clinical training, 2) lack of objective criteria for the evaluation of clinical training, 3) lack of involvement of students in clinical patient management, 4) needs of improvement in contents of clinical education, 5) lack of strict execution of education program, 6) lack of places for clinical education, 7) lack of interests in clinical training of the staffs, 8) needs of the orientation for the students about hospital systems. With this summary we held workshop for the staffs (29) in charge of clinical education. The summarized methods to improve clinical education were to promote interests in clinical education of staffs, to select the personnel in charge of clinical education, to make assignment of patient to the students, to let the student write patient progress note, to improve evaluation method for clinical education, to orient student about clinical education.
Education ; Humans ; Linear Energy Transfer ; Medical Staff ; Students, Medical* ; Surveys and Questionnaires

PURPOSE: Since the hand elevation test was first introduced by Ahn in 2001, it has been one of most performing provocative test for diagnosing carpal tunnel syndrome. Although many studies have been published on the hand elevation test, there are no study that can explain why false-negative results of hand elevation test appears in carpal tunnel syndrome patients diagnosed by electromyography (EMG) findings. Therefore we searched out whether hand elevation test is related with EMG severity. MATERIALS AND METHODS: We made a retrospective study of 654 bilateral carpal tunnel syndrome patients. Among them 134 were studied which had different hand elevation test results on each hands. The paired samples t-test was used to compare the EMG severity of each group. The relationships between hand elevation test and EMG severity were examined using Pearson-product correlations. Comparing whether the frequency of false negative hand elevation were different between both hands, and whether the severity of EMG depends on which side of hand is, was evaluated with Mann-Whitney U-test. RESULTS: Severity of EMG in positive group was moderate to severe on average, whereas mild to moderate on negative group, with significant difference statistically (p<0.001). Correlation between the hand elevation test results and EMG severity also showed significance statistically (p<0.001). CONCLUSION: Mild severity of EMG was found out to be the factor affecting the false results. However, EMG severity and hand elevation test shows a meaningful correlation, supporting the value of hand elevation test.
Carpal Tunnel Syndrome* ; Electromyography* ; Hand* ; Humans ; Retrospective Studies

PURPOSE: This study evaluated outcomes of radiotherapy (RT) after chemotherapy in limited-stage head-and-neck diffuse large B-cell lymphoma (DLBCL). MATERIALS AND METHODS: Eighty patients who were treated for limited-stage head-and-neck DLBCL with CHOP (n = 43) or R-CHOP (n = 37), were analyzed. After chemotherapy, RT was administered to the extended field (n = 60) or the involved field (n = 16), or the involved site (n = 4). The median dose of RT ranged from 36 Gy in case of those with a complete response, to 45–60 Gy in those with a partial response. RESULTS: In all patients, the 5-year overall survival (OS) and disease-free survival (DFS) rates were 83.9% and 80.1%, respectively. In comparison with the CHOP regimen, the R-CHOP regimen showed a better 5-year DFS (86.5% vs. 73.9%, p = 0.027) and a lower rate of treatment failures (25.6% vs. 8.1%, p = 0.040). The volume (p = 0.047) and dose of RT (p < 0.001) were significantly reduced in patients treated with R-CHOP compared to that in those treated with CHOP. CONCLUSION: The outcomes of RT after chemotherapy with R-CHOP were better than those of CHOP regimen for limited-stage head-and-neck DLBCL. In patients treated with R-CHOP, a reduced RT dose and volume might be feasible without increasing treatment failures.
Antineoplastic Agents ; B-Lymphocytes* ; Disease-Free Survival ; Drug Therapy ; Head and Neck Neoplasms ; Humans ; Lymphoma, B-Cell* ; Radiotherapy* ; Treatment Failure

To investigate the clinical usefulness of the intravenous anesthesia of the facial chemical peeling with midazolam(0.1 mg/kg)-fentanyl(3 ug/kg) - esmolol(initial 500 ug/kg,maintenance 200 ug/kg/min), the authors took 133 cases into consideration. The results of the statistical evaluation were as follows: 1) Most of the cases were small pox scar(70.7%). 2) One point five percent of the cases dreamed during anesthesia. 3) Ninety-four point seven percents of the cases were in the emotion of "Peaceful and relaxed" and 60.1% of them were in the mood of Pleased or very pleased and the others were "So and so". 4) Ninety-one point seven percents of the cases were willing to choose the same anesthetic method next time. 5) Fifty-two point six percents of the cases showed hypertensive episodes during anesthesia. 6) The incidence of the cases with SaO lower than 85% was 36.8%. The anesthetic technique with intravenous midazolam-fentanyl-esmolol for the facial chemical peeling with trichloroacetic acid(TCA) gives the patient comfortness and preference for this anesthetic technique. Close monitoring of the respiration is needed, because it can depress respiratory function. And control of the high blood pressure during anesthesia seems to be needed.
Anesthesia* ; Anesthesia, Intravenous ; Deep Sedation* ; Dreams ; Fentanyl* ; Humans ; Hypertension ; Incidence ; Midazolam* ; Respiration

BACKGROUND AND OBJECTIVES: Cavernous sinus is a small venous space enclosed by leaves of dura and periosteum and located on either side of sella turcica. Approach and treatment of lesions of this sinus are very difficult and perilous because they contain critical neural and vascular structures. Surgery relating to cavernous sinus lesions are extremely rare in otorhinolaryngology and such surgeries are usually referred to the fields of neurology and neurosurgery. However, in the case of a lesion that extends from the nasal cavity and the paranasal sinuses, an intranasal approach is necessary and cooperation with head and neck surgeons are desirable to achieve a superior result. This study examines the nature of these rare cases of cavernous sinus lesions and assesses the results of cooperation with doctors of other specialties. MATERIALS AND METHODS: We summarize here three cases of cavernous sinus lesions (angiofibroma, tuberculosis, foreign body) extendeding from the nasal cavity and paranasal sinuses. These lesions were treated in cooperation with a reconstructive surgeon and a neurosurgeon. RESULT: All of these cases showed successful results. CONCLUSION: Close cooperation from each department is critical in order to achieve successful results.
Angiofibroma ; Cavernous Sinus* ; Foreign Bodies ; Head ; Nasal Cavity ; Neck* ; Neurology ; Neurosurgery ; Otolaryngology ; Paranasal Sinuses ; Periosteum ; Sella Turcica ; Tuberculosis

T cell large granular lymphocytic leukemia (T-LGL leukemia) is defined as a clonal proliferative disorder of CD3+ cytotoxic T cells. T-LGL leukemia usually expresses CD3+, CD4-, CD8+, CD16+, CD56- and CD57+ cell markers, and this represents a rearrangement of the T cell receptor (TCR) gene. The clinical course is indolent in most cases, but on rare occasions, when CD3+ and CD56+ are expressed on the leukemic cells, it can be more aggressive. We experienced a patient with T-LGL leukemia and the disease was indolent at the time of diagnosis, and so any specific treatment was not required. Two years after the initial diagnosis, her clinical course became quite aggressive as the CD 56+ cell surface antigen was expressed. We report here on the first case of T-LGL leukemia in Korea and we review the relevant literature.
Antigens, CD3 ; Antigens, CD56 ; Antigens, Surface ; Humans ; Korea ; Leukemia, Large Granular Lymphocytic ; Receptors, Antigen, T-Cell ; T-Lymphocytes

BACKGROUND AND PURPOSE: Hemicraniectomy is a decompressive surgery used to remove a large bone flap to allow edematous brain tissue to bulge extracranially. However, early indicators of the decompressive effects of hemicraniectomy are unclear. We investigated whether reduction of midline shift following hemicraniectomy is associated with improved consciousness and survival in patients with malignant middle cerebral artery infarctions. METHODS: We studied 70 patients with malignant middle cerebral artery infarctions (MMI) who underwent hemicraniectomies. Midline shift was measured preoperatively and postoperatively using computed tomography (CT). Consciousness level was evaluated using the Glasgow Coma Scale on postoperative day 1. Patient survival was assessed six months after stroke onset. RESULTS: The median time interval between preoperative and postoperative CT was 8.3 hours (interquartile range, 6.1–10.2 hours). Reduction in midline shift was associated with higher postoperative Glasgow Coma Scale scores (P<0.05). Forty-three patients (61.4%) were alive at six months after the stroke. Patients with reductions in midline shifts following hemicraniectomy were more likely to be alive at six months post-stroke than those without (P<0.001). Reduction of midline shift was associated with lower mortality at six months after stroke, after adjusting for age, sex, National Institutes of Health Stroke Scale score, and preoperative midline shift (adjusted hazard ratio, 0.71; 95% confidence interval, 0.62–0.81; P<0.001). CONCLUSIONS: Reduction in midline shift following hemicraniectomy was associated with improved consciousness and six-month survival in patients with MMI. Hence, it may be an early indicator of effective decompression following hemicraniectomy.
Brain ; Consciousness ; Decompression ; Decompressive Craniectomy ; Glasgow Coma Scale ; Humans ; Infarction ; Infarction, Middle Cerebral Artery* ; Middle Cerebral Artery* ; Mortality ; National Institutes of Health (U.S.) ; Stroke

PURPOSE: The major limitation of adult-to-adult living donor liver transplantation (A-A LDLT) is the adequacy of the graft size. As an alternative, dual grafts from two living donors can solve the problem of graft-size insufficiency and guarantee the donor safety in many occasions. The present study aims to introduce the usefulness of dual-grafts A-A LDLT by review of our single center experience. METHODS: After the first successful pediatric LDLT in December 1994 and A-A LDLT in February 1997, 392 LDLTs including 73 pediatric and 319 adult cases were performed at Asan Medical Center until December 2001. Among 319 A-A LDLTs, 20 recipients implanted dual grafts were retrospectively analysed from March 2000 to December 2001. RESULTS: The ratio of graft volume to standard liver volume of the recipients ranged from 46.6% to 78.9%. More than 50% of the standard liver volume of the recipients was implanted in 16 patients. There was acute rejection episode in two patients, which were responded by pulsed steroid therapy. There were 3 in- hospital mortality (<3 month posttransplantation). CONCLUSION: In LDLT, the donor safety is the major concern. Although the donor has a large right lobe of liver that is adequate as a graft for large-size recipient, the remaining left lobe of liver is sometimes too small to endanger the donor safety. In this circumstance, the donor cannot be accepted to donate his or her right or left lobe of liver. Dual grafts from two living donors can help to alleviate the problem of small-for-size graft and secure the donor safety.
Adult ; Chungcheongnam-do ; Hospital Mortality ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Retrospective Studies ; Tissue Donors ; Transplants*