Bone graft is an important procedure in craniomaxillofacial reconstruction and the success of reconstruction depends on the survival of the grafted bone. In this study, the survival of the membranous inlay bone graft on the mandibles of dogs was investigated with bone scan and histologic examination. The inlay bone graft, 1x2cm critical-sized bone, was completely separated from the lower border of the mandible of dogs and then refixed to the original site. Bone scan and histologic examination were done at 1,2,3 and 4 weeks postoperatively. The bone scan after 1 week showed radioisotope uptake on the margin of the grafted bone and the isotope count was 21% compared to the uptake of the normal bone. After 2 weeks, the radioisotope uptake in the grafted bone increased to 52% of normal bone uptake. After 3 and 4 weeks, the degree of isotope uptake was 111% and 124% respectively. Histological findings after 1 week showed the absence of osteoblastic activity and 6 viable blood vessels in one 200X magnified field, which was 25% compared to the vessels of the normal bone. After 2 weeks, osteoblastic activities were noted and the number of viable blood vessels totalled 15, which was 63% of the vessels of the normal bone. After 3 weeks, osteoblastic activities increased and the number of viable blood vessels totalled 21, which was 88% of the vessels of the normal bone. After 4 weeks, there were markedly increased osteoblastic activities with a total number of 23 vessels, which was 96% of the normal bone. In summary, the revascularization of the membranous inlay bone graft began from the first week after bone graft, and then it gradually increased. After 3 weeks, the revascularization had returned to a nearly normal value compared with the value of the near-by normal mandibular bone.
Animals ; Blood Vessels ; Dogs ; Inlays* ; Mandible* ; Osteoblasts ; Reference Values ; Transplants*

No abstract available.

In modem medical industries as in others, it has been emphasized by many experts such as Dr. Mayer and Dr. Donabedean that there should be quality assurance activities applying statistical knowledges in the processes of medical management and medical staff themselves for the better medical care and customer satisfaction. Three of our quality assurance programs for the purpose of shortening the treatment time In the department of emergency medicine in Keimyung University, Dong-San Medical Center had been carried out during the period of June 94 through December 95. Our methodology was mainly the process emphasized ; finding the causes of delaying factors in various processes related to the works of nurses, doctors, laboratory services, radiology services etc. in the emergency room, holding various meetings among the related groups with genuine discussions, notifying the new results in each step, encouraging the positive ones and also applying the new leadership technics. During the period of June 94 through December 95(for 1.5 years), the average E.R. patient treatment time from registrations to dispositions had been reduced by about 2 hours (from 5 hours 3 minutes to 2 hours 5 minutes) and its variations among the different specialities had been narrowed down to significant degree (p<0.05) revealing the preprogram base line standard deviation of 2.43 to 1.28 in post program through continuous quality assurance programs. It was also noted that the successful results of Q/A program have been closely related to the fact that the process should be designed and redesigned repeatly as needed and that all the participants related were actively involved in the planning and redesigning processes.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leadership ; Medical Staff ; Modems

Neurologic disorders from electrical injury may be classified as cerebral syndroms, spinal syndroms, peripheral nerve syndromes. Neurological complication involving either cerebral complication (loss of consciousness, seizures, decreased memory, headache) or peripheral complaints (sensorimotor loss, paraesthesias, paralysis, paresis, dysthesias) are described in the current literatures. However, the exact site of neurological damage causing paralysis after electrical trauma ramains to be clarified. Although transient tetraplegia has been previously reported following high-voltage electrical injury, the following case report describes an unusual presentation of transient acute tetraplegia following a low-voltage electrical injury.
Consciousness ; Memory ; Nervous System Diseases ; Paralysis ; Paresis ; Peripheral Nerves ; Quadriplegia* ; Seizures ; Shock* ; Spinal Cord Injuries

To have useful information and basic rationale for selection of suture materials in the subcutaneous buried suture, a study on tensile strength, clinical handing property, scar nature and histological changes was done in rabbits with four kinds of absorbable suture materials (chromic catgut, Monocryl, coated Vicryl and PDS) and two kinds of nonabsorbable suture materials (Nylon and Gore-tex). The clinical handling property included pliability, ease of tying, knot security and passage in tissue. The tensile strength of the absorbable and non-absorbable suture materials was compared before and after subcutaneous implantation, and the histology of suture materials was examined after separate subcutaneous buried sutures. The test of tensile strength and the histological examination of suture materials were done on the 1st, 3rd, 7th, 14th, 30th and 90th day after subcutaneous implantation and suturing. In the clinical handing property, pliability was good in Vicryl. Ease of tying and knot security were good in both catgut and Vicryl, but passage in tissue was poor in both. In Gore-tex, pliability, ease of tying, knot security and tissue passage were better than Nylon. In the tensile strength of absorbable suture materials before implantation in the abdominal flap, Monocryl was the strongest one and catgut was the weakest one. Vicryl was a little stronger than PDS. The tensile strength of Moncryl rapidly dropped down from the 3rd day after implantation and became the weakest one after the 7th day of implantation. There was no remarkable change in the strength order of other absorbable suture materials. In the non-absorbable suture materials, Gore-tex was about two times stronger than Nylon before and after implantation. In histology, there were more severe and prolonged inflammatory reactions in absorbable suture materials than in nonabsorbables. The most severe reaction was seen in catgut. Monocryl, Vicryl and PDS were similar in inflammatory reaction. Severe giant cell and histiocytic reaction were seen in Vicryl. The least absorption was seen in PDS and it was well correlated with loss of tensile strength. Nylon showed less inflammatory reaction than Gore-tex. There are few clinical studies for recently developed Monocryl and Gore-tex. Our results suggest to us that Monmcryl is one of the best absorbable suture materials and Gore-tex is two times stronger than Nylon.
Absorption ; Catgut ; Cicatrix ; Giant Cells ; Hand ; Nylons ; Pliability ; Polyglactin 910 ; Polytetrafluoroethylene ; Rabbits* ; Sutures* ; Tensile Strength

Soluble compounds of chromium are widely used in industrial processes, including printing, photography, pyrotechnics, dyeing, electroplating, aircraft, shipbuilding, and leather tanning. Exposure in industry is generally via the inhalation of dusts and fumes. Ingestion of chromium (chromate or dichromate salt) has occurred accidentally in suicide attempts and during drug experimentation and may causes ulceration of the bowel, diarrhea, hemorrhagic diathesis, acute renal failure, and hepatic damage. Ingestion of hexavalent chromium com-pounds is considered to be one hundred times more toxic than the trivalent compounds. Chromium poisoning in children is an uncommon, potentially lethal form of poisoning which could possibly increase in incidence because of the resumed greater domestic distribution of dichromate in Korea. We report a case of ammonium dichromate inges-tion by a child that resulted in a healthy discharge.
Acute Kidney Injury ; Aircraft ; Ammonium Compounds* ; Child ; Chromates ; Chromium ; Diarrhea ; Dust ; Eating ; Electroplating ; Hemorrhagic Disorders ; Humans ; Incidence ; Inhalation ; Korea ; Photography ; Poisoning* ; Suicide ; Tanning ; Triacetoneamine-N-Oxyl ; Ulcer

Primary segmental omental infarction in adults is very rare and occasionally occurs due to impaired perfusion to the greater omentum. Most authors believe that the condition results from an embryologic variant associated with anomalous and fragile blood supply of the right lower portion of the greater omentum, which is consequently susceptible to infarction. Since there are no characteristic clinical findings, the clinical presentation often mimics acute appendicitis or cholecystitis. However, in the proper clinical setting, the correct diagnosis can be established by the radiologist; therefore, unnecessary surgery can be avoided in many cases. Cross-sectional imaging by ultrasound or computed tomography will demonstrate characteristic findings in a location corresponding to the patient's point of maximal tenderness. These findings consist of an ovoid or cake-like mass in the omental fat with surrounding inflammatory changes. We report a case of primary segmental omental infarction in an adults who was treated conservatively after the diagnosis was established with clinical findings.
Abdominal Pain ; Adult ; Appendicitis ; Cholecystitis ; Diagnosis ; Humans ; Infarction* ; Omentum ; Perfusion ; Ultrasonography ; Unnecessary Procedures

The goals of the reduction mammoplasty are to reduce the volume of the breast, to create aesthetic shape that is stable over time, to maintain blood supply and innervation to the nipple-areolar complex, and to make fine limited scars. There are 3 rationales in our reduction mammoplasty. To reduce the scar, we perform the periareolar incision. To make effective reduction of the breast volume, and to preserve blood supply and innervation to the nipple-areolar complex, we use a central or an inferior pedicle technique. To prevent areolar widening, we use a purse-string suture. We performed the periareolar reduction mammoplasty to 36 breasts in 18 patients from Jul. 1998 to Jun. 2000. The mean follow up period was 8 months. The mean age was 41 and mean resection amount was 420 gm per breast. Most patients satisfied with their fine periareolar scars, adequate size of breasts and the innervation of the nipple-areolar complex. We applied this procedure to all kinds of macrostomia. The greatest advantage of the periareolar reduction mammoplasty is the inconspicuous limited scar. Other advantages over conventional technique include preservation of sensitivity to the nipple-areolar complex and shorter operative time. As disadvantages, 10 breasts(28%) showed areolar widening. In 8 of 10 breasts with areolar widening, purse-string suture was not applied in the skin flap margin of the outer circle and reoperation was executed to reduce the areolar size by excision of the widened areola. The application of the purse-string suture was carried out in 6 breasts. Two breasts with purse-string suture showed areolar widening possibly due to loosening of the purse-string suture knot. There were persistent periareolar wrinkles in 4 breasts and poor sensitivity to the nipple-areolar complex in 6 breasts in which more than 500 gm of breast tissue per breast was resected. Periareolar reduction mammoplasty is optimal for patients who require reduction of lesser than 500 grams per breast. In the severe macromastia with or without ptosis, inverted T-incision is preferable to the periareolar incision, and periareolar incision can be modified by adding wedge resection of the outer excess skin flap inferiorly which results in a periareolar and vertical scar below the nipple-areolar complex.
Breast ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Macrostomia ; Mammaplasty* ; Operative Time ; Reoperation ; Skin ; Sutures

Clinical problem occuring in the early post operative period after cardiopulmonary bypass may ne related to the altered function of capillary bed which was affected by activation of complement system. This is so called post perfusion syndrome. We selected 20 patients with confirmed congenital heart disease by cariac catheterization. We studied the changes in the C3 , immunolglobulins, total protein, and WBC count while performing open heart surgery. The results were as followed. 1. C3 level was lowest during cardiopulmonary bypass and returned to the normal level after 8 days. 2. Each immunoglobulin level decreased just after cardiopulmonary bypass, especially the IgG level, and immunoglobulins slowly returned to the normal range after 8 days. 3. Serum total protein level and electrophoretic fractions were comperatively reduced as much as immunoglobulin levels. 4. WBC count was lower just before cardiopulmonary bypass than baseline.
Capillaries ; Cardiopulmonary Bypass* ; Catheterization ; Catheters ; Complement System Proteins* ; Heart Defects, Congenital ; Humans ; Immunoglobulin G ; Immunoglobulins ; Oxygenators ; Perfusion ; Reference Values ; Thoracic Surgery

The use of somastostatin in chyle fistula that occurs after neck dissection is a new approach that has been reported in few cases. We report two cases of chyle fistula that occurred after neck dissection, which were successfully managed with somatostatin subcutaneous injection. Somatostatin treatment resulted in an immediate reduction of chyle leakage in both patients, and might have contributed to the reduction of patients' morbidity and duration of hospital stay. However, optimal treatment regimen with somatostatin is unclear because of its limited case and various administration methods. Further studies are required to clarify the usefulness and optimal regimen of somatostatin injection in the treatment of chyle fistula following neck dissection.
Chyle ; Fistula ; Humans ; Injections, Subcutaneous ; Length of Stay ; Neck ; Neck Dissection ; Octreotide ; Somatostatin