The midface are bounded by a line connecting the two zygomaticofrontal suture, passing through the frontomaxillary and frontonasal suture, and limited below by the occlusal plane of maxillary teeth. Midface fractures include fractures affecting the maxilla, the zygoma, and the nasoorbital ethmoid complex. Midface fractures can be classified as LeFort 1, II, III fractures, sygomaticomaxillary complex fractures, zygomatic arch frationctures, or nasoorbital ethmoid fractures. These injuries may be isolated or occur in combine. And sort tissue injuries to the facial structures are commonly encountered in the treatment of midface fractured patient. Soft tissue wounds may be limited to the superficial structures, but more serious injuries may extend to involve anatomic structures such as the sensory and motor nerves of the face; the parotid, or nasolacrimal glands or ducts ; or the dentoalveolar structures. Especially, these fractures are combined with the orbit, brain injuries and skull base fractures. This is to report the incidence, causes, criteria, complication and treatments of patients who visited our department for midface fracture, for last 10 years.
Brain Injuries ; Dental Occlusion ; Humans ; Incidence ; Maxilla ; Orbit ; Skull Base ; Sutures ; Tooth ; Wounds and Injuries ; Zygoma ; Zygomatic Fractures

BACKGROUND: It is well known that ischemic preconditioning protects the heart against infarction or arrhythmias from a subsequent ischemic injury. Recent laboratory data indicate that the adenosine during the ischemic period may trigger protection via A1 or A3 adenosine receptor and also protein kinase C(PKC) plays a central role. This study was designed to determine the role of adenosine receptor subtypes and PKC in the preconditioning protection. METHODS: All cat heart groups were subjected to 40min ischemia and 30min reperfusion. The preconditioning protocol consists of 4min ischemia and then 10min of reperfusion 4 times. The effects of ischemic preconditioning, nonselective adenosine receptor blocker(SPT), an A1 specific antagonist(DPCPX) and protein kinase C inhibitor(Polymyxin B), on ischemic preconditioning were determined by infarction size. There were 5 groups : (1) control group (Group 1, n=10)(2) Ischemic preconditioned group(Group 2, n=9)(3) DPCPX pretreatment group(Group 3, n=6)(4) SPT preteatment group(Group 3, n=6)(5) Polymyxin B pretreatment group(Group 5, n=6). SPT and DPCPX were given intravenously 5 min before ischemic preconditioning. Polymyxin B was administered to cats for 30min during ischemic preconditioning period. RESULTS: Ischemic preconditioning only or pretreatment with DPCPX prior to preconditioning demonstrated a significant reduction in infarct size(22.6+/-1.5, 25.4+/-0.9% infarction of the risk zone, respectively, p<0.05) with respect to control, SPT-pretreatment, and polymyxin B-pretreatment groups(44.0+/-1.7, 43.0+/-2.0 and 40.3+/-0.4% infarction of the risk zone, respectively). CONCLUSIONS: Ischemic preconditioning protects heart from subsequent ischemia. Protection was blocked by SPT and protein kinase C inhibitor(polymyxin B), but not by A1 antagonist DPCPX. The cardioprotective effects by ischemic preconditioning in the in vivo cat heart appear to be dependent on A3 adenosine receptors and activation of protein kinase C.
Adenosine* ; Animals ; Arrhythmias, Cardiac ; Cats* ; Heart* ; Infarction ; Ischemia ; Ischemic Preconditioning* ; Polymyxin B ; Polymyxins ; Protein Kinase C* ; Protein Kinases* ; Receptors, Purinergic P1* ; Reperfusion

No abstract available.
Thyroid Gland* ; Thyroid Nodule*

Background: Fine needle aspiration and biopsy(FNAB) has known the most accurate test(about 90%) in the preoperative evaluation of patients with a thyroid nodule. The false negative findings of thyroid cancer by FNAB are mainly due to the aspiration of cystic fluid in cystic degeneration of thyroid cancer and the ipossibility of differentiation between follicular adenoma and carcinoma by aspiration or FNAB because of the failure to evaluate the capsule invasion or angioinvasion of the tumor. Actually more than 80% of the nodules are found as benign nodules in aspiration or FNAB and the findings of follieular lesions are found about half of the samples tested, so limiting the cancer incidence in surgically resected samples up to 50% of the surgical resection. Sa reasonable guidelines to manage the benign nodules on aspiration or FNAB are needed which can select the maligna~nt nodules with false negative findings on aspiration or FNAB. We tried to evaluate whether the thyroxine suppression therapy can increase the malignancy rates on thyroidectomy, Methods: We treated the benign thyroid nodules in FNAB with thyroxine for 1 year and cornpared the nodule volume change before and after treatment (every 6 month) with ultrasonogram. We performed thyroidectomy on 1~7 thyroid nodules wbich showed less than 50% decrease of nodule volume after 1 year of thyroxine suppression therapy. Results: The results were as follows. 1) Of all 17 patients, surgical resection revealed malignant thyroid nodule(Group I) in 10 cases (58.82%, papillary cancer. 6 cases, follicular cancer: 4 cases) and benign thyroid nodule(Group II) in 7 cases(41.18%, follicular adenoma: 4 cases, adenomatous goiter: 3 cases). 2) Between group I and II, there was no significant differences in serum T, T and TSH levels before and after thyroxine suppression therapy. Also, there were no significant difference in TSH suppression % between group I and group II(5.60+5.39%, 14.64+11.48%, respectively). 3) Thyroid nodule volume decrease percent before and after thyroxi~ne therapy showed no significant difference between group I and group II (124.80+54.18% vs 159.42+79.82%, p>0.05). Conclusion: Our data suggested that the benign thyroid nodules on aspiration or FNAB which were not suppressed in volume after thyroixine therapy revealed more than 50% incidence of malignancy on surgical resection, so these nodules were highly reeommended to surgical exploration.
Adenoma ; Biopsy, Fine-Needle ; Goiter ; Humans ; Incidence ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroxine ; Ultrasonography

To evaluate in vitro anti-HIV efficacies of nucleoside derivatives, MT-4 cell line was infected with HIV-1 and HIV-2 respectively and treated with various compounds and the formerly approved drugs such as AZT, d4T, ddC and ddI. CPE method was used to evaluate their antiviral activity Most dideoxynucleosides, AZT, d4T, ddC and ddI, showed anti-HIV activities against both viruses but no other compounds including anti-herpesvirus drugs did any. Further experiments were carried out to study their inhibitory mechanism of viral adsorption. The results showed no inhibition of syncytium formation due to an interaction between the gp120 expressed in HIV-infected cell surface and CD4 receptor on the uninfected cell surface in the presence of AZT. AZT showed no activity up to 100 microgram/ml. Inhibition of reverse transcriptase (RT) in the presence of AZT-triphosphate was tested by using RT expressed in E. coli and purified and its IC50 was 4.5 nM.
Adsorption ; Cell Line ; Dideoxynucleosides ; Giant Cells ; HIV-1 ; HIV-2 ; Inhibitory Concentration 50 ; RNA-Directed DNA Polymerase ; Stavudine

No abstract available.
Pregnancy*

During the eleven months from September, 1989 to July, 1990, a total of 118 subarachnoid hemorrhage(SAH) patients were admitted. Among these, in 2 cases, the etiology was unknown and another 8 cases of Hunt & Hess clinical grade V patients died in the emergency room or intensive care unit within 24 hours after admission. The remaning 108 cases were managed with protocol as follows. 1) Surgery was done within 9 days after the SAH(total 67 cases) : Extraventricular drainage(EVD) was performed and a cisternal drainage(CD) catheter was positioned during surgery. EVD, CD nimodipine irrigation(0.4mg) through the CD catheter, and intravenous injection(IV) of nimodipine(1~2mg/hr)continued for 13days after the SAH. 2) Surgery was done after the 9th SAH day due to late transfer neurology or other hospitals or posterior circulation aneurysms(32 cases), and 9 cases refused surgery : Nimodipine was used orally(240mg/day) in 35 cases and an IV route(1~2mg/hr) in 6 cases. Total management outcome and results were obtained as follows. 1) A total unsatisfactory management outcome was 18.52%(serve disabled : 4.63%, vegetative : 0.93%, death : 12.96%. In the surgical cases only, 40.8%, 1.02%, 9.19%, respectively). 2) An unsatisfactory surgical outcome in cases following surgery after the 9th SAH day was 6.24%(severe disabled : 3.12%, death : 3.12%). 3) An unsatisfactory management outcome in cases of admission grades I & II following surgery within the 9th SAH day or those non-surgical patients was 19.15%(severe disabled : 4.25%, death : 14.89%. In surgical cases only 2.33%, 9.30%, respectively). 4) An unsatisfactory management outcome in cases of admission grades III & IV with surgery within the 9th SAH day or non-surgical patients was 29.63%(severe disabled : 7.41%, vegetative : 3.70%. death : 18.52%. In surgical cases only 9.09%, 4.55%, 13.64%, respectively). One case of admission grade V died. 5) Causes of unsatisfactory outcome were vasospasm : 9 cases(8.33%), SAH itself : 4 cases, rebleeding : 3 cases, surgical complication : 1 case, medical complication : 1 case, anesthesia : 1 case, and head trauma : 1 case. 6) Complications in management protocol with EVD, CD, CD nimodipine irrigation, and IV of nimodipine were transient hypotension(1 case) and meningitis(5 cases). These complications were improved without sequelae with discontinuing the IV of nimodipine and using antibiotics. We concluded that this protocol may improved the total management outcome of aneurysmal SAH patients, especially poor grade patients(Hunt & Hess grade III & IV) without significant complications. However, in spite of this protocol, the leading cause of an unsatisfactory outcome is vasospasm.
Anesthesia ; Aneurysm ; Anti-Bacterial Agents ; Catheters ; Craniocerebral Trauma ; Drainage* ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Intracranial Aneurysm* ; Neurology ; Nimodipine*

No abstract available.
Radiosurgery* ; Trigeminal Neuralgia*

Activation of the sympathetic nervous system in mediating the stress response attends traumatic brain injury. Plasma dopamine(DA), epinephrine(E), norepinephrine(NE) levels were measured in 26 severe traumatically brain injured patients to determine whether catecholamine levels obtained within 24 hours after injury provide reliable prognostic endogenous markers of outcome. Patient outcome was determine at 1 week using the Glasgow Coma Scale(GCS) and at the time of discharge the Glasgow Outcome Scale(GOS), 7 patients with diseases except those with a severe traumatic brain injury were selected as a control group. Firstly, we analyzed the difference of the average DA, E, and NE between the control group and severe traumatic brain injury patients. Secondly, we analyzed the difference of the average catecholamine levels in the 3 groups according to admission GCS scores(respectively 3~4, 5~7, 8~9). Third, we analyzed the difference of the average catecholamine levels in the 5 groups according to GOS scores at 1 week(respectively dead, 3~4, 5~7, 8~11, >11). Finally, we analyzed the difference of the average catecholamine levels in the 5 groups according to GOS at the time of discharge. As a result, there was no statical difference between the level of DA in the control group and those of the severe brain injury patients. But the level of E an NE in the experimental group were higher than the control group(respectively p<0.03, p<0.04). The admission GCS score correlated highly with the catecholamine levels(NE : r=0.69, p<0.001 ; E ; r=0.42, p<0.03 ; DA ; r=0.42, p<0.03). In patients with admission GCS of 3 to 4, NE levels increaed fourfold above other group(p<0.005). In the 13 patients with GCS scores of 3 or 4 on admission. NE levels predicted outcome at 1 week. All two patients with NE levels less then 750 pg/ml were survived, while 10 of 11 with NE levels greater than 750 pg/ml were died(p<0.02). The levels of NE was significantly higher in patients who died than in those with better outcome(p<0.02). Therefore, these findings indicated that the level of circulating NE is an excellent endogenous marker that appear to reflect the extent of brain injury and that may predict the likelihood of recovery.
Brain ; Brain Injuries* ; Coma ; Dopamine ; Epinephrine ; Humans ; Negotiating ; Norepinephrine ; Plasma* ; Prognosis* ; Sympathetic Nervous System

No abstract available.
Humans ; Hypertension* ; Kidney Failure, Chronic* ; Renal Insufficiency*