Microvascular tissue transfers have facilitated primary closure of various complex defects after radical ablation of head and neck cancers. From Oct 1991 to Feb 1992, we used forearm free flap in two patients and delto-pectoral flap in one patient who had preoperative irradiation for pharyngoesophageal reconstruction. The stricture and fistula formation were most troublesome complication in forearm free flap, so we designed as lazy S shape in distal flap margin to prevent circular contraction and longitudinal margin was deepithelialized (5 mm) and sutured double layer to withstand fistular formation and this can be considered useful in place of a free jejuna transfer.
Constriction, Pathologic ; Fistula ; Forearm ; Free Tissue Flaps ; Head ; Humans ; Neck

We investigated the occurrence of color vision loss in 70 organic solvent mixtures exposed workers and in 47 controls. Color Vision was assessed with a color arrangement test designed to identify the defective color sense, the Han Double 15-Hue Test. The results of the test were no significant difference between exposed workers and controls in the proportion of subjects who committed one or two errors. Quantitative analysis, using color confusion index(CCI), showed no signifiant difference between exposed workers and controls. A significant linear correlation was present between age and CCI in both exposed workers(CCi=0.0056age + 0.94; r=0.23; p<0.05) and controls(CCI=0.0066age + 0.86; r=0.33; p<0.05). Qualitative analysis of the patterns on the hue circle showed that the prevalence of acquired dyschromatopsia was 21% in both and no significant difference. Multiple regression analyses showed that age was significantly related to color vision loss. These results did not provide evidence of a relationship between organic solvents exposure and incidence of color vision loss. In field studies for monitor the people at risk of the acquired color vision loss involving low-dose organic solvents exposed workers, both quantitative and qualitative information should be considered.
Color Vision ; Incidence ; Prevalence ; Solvents

No abstract available.
Digoxigenin* ; DNA* ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis*

OBJECTIVES: The K-ARS(Korean ADHD Rating Scale) is one of the most important assessment tool of attentiondeficit hyperactivity disorder(ADHD) in Korea. In this study, we presented detailed normative data on the K-ARS for school-aged children in Seoul metropolitan area to put it to practical use. METHODS: The subjects were 2,397 students(1,223 boys and 1,174 girls, aged 6-12) from 4 elementary schools in Seoul, and one caretaker of each child completed the K-ARS for parents. Children who showed high scores of the KARS for parents were screened, and 2 child psychiatrists interviewed them to make a clinical diagnosis. We compared the mean scores of the K-ARS for parents between ADHD and normal group, and examined the percentage of correct classification. RESULTS: There were some differences in score of the K-ARS for parents according to sex and age, so we presented continuous normative data with T score and subdivided cut-off points for ADHD screening. Interviews with child psychiatrists using DSM-IV criteria were performed to test diagnostic validity, and the difference in every the K-ARS for parents index between ADHD and normal group was significant(p<.001). Using 3 different cut-off points(80th, 90th, 93rd percentage), the accuracies of ADHD correct classification were 67.9, 72.2, 71.1% and all 3 canonical discriminants were significant(p<.05) between ADHD and normal group. CONCLUSION: The normative data and cut-off points on the K-ARS for parents are useful in screening ADHD children in Seoul metropolitan area.
Child ; Classification ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Korea ; Mass Screening ; Parents* ; Psychiatry ; Seoul

No abstract available.
Anxiety* ; Depression* ; Headache*

Angioedema is a non-pitting edema that occurs in the skin and mucus membranes. It is known that major etiologies include hereditary deficiency of C1 esterase inhibitor, temperature extreme, trauma, food sensitivity, and medications such as penicillin, aspirin, NSAIDS and ACE inhibitors. ACE inhibitors are blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, and increasing local levels of bradykinin, a potent vasodilator. This increased bradykinin has been theorized to cause angioedema and cough in patients on ACE inhibitors. However, there has been very few causes of angioedema induced by angiotensin II receptor blocker. This is the first report of a patient presenting angioedema induced by losartan -angiotensin II receptor blocker- in this century.
Angioedema* ; Angiotensin I ; Angiotensin II ; Angiotensin-Converting Enzyme Inhibitors ; Anti-Inflammatory Agents, Non-Steroidal ; Aspirin ; Bradykinin ; Cough ; Edema ; Hereditary Angioedema Types I and II ; Humans ; Losartan* ; Membranes ; Mucus ; Penicillins ; Receptors, Angiotensin ; Skin

Recurrent bacterial meningitis can be caused by acquired or congenital anatomic defects, infection, or alterations in immune mechanism. Intracranial anatomical defects possibly combined with trauma can be the major cause of recurrent bacterial meningitis. Mucocele is a chronic, expansile and cyst-like lesion of the paranasal sinuses, most frequently found in the frontal sinus containing sterile mucoid secretions. Secondary infection of a mucocele may create a pyocele. Although pathogenesis of a primary mucoceles remains uncertain, causatives factors of secondary mucoceles have been suggested to include chronic inflammation, trauma, allergy and obstructing tumors. We experienced a case of recurrent bacterial meningitis with frontal sinus mucocele, which might be secondary to cranial trauma.
Coinfection ; Frontal Sinus ; Hypersensitivity ; Inflammation ; Meningitis, Bacterial* ; Mucocele* ; Paranasal Sinuses

PURPOSE: We investigated types and prevalence of coexisting lesions found on whole spine sagittal T2-weighted images (WSST2I) acquired from magnetic resonance imaging (MRI) and evaluated their clinical significance in surgical degenerative spinal diseases. MATERIALS AND METHODS: Coexisting spinal lesions were investigated using WSST2I from 306 consecutive patients with surgical degenerative spinal diseases. Severity of coexisting lesions was classified into four grades (0-3). Lesions of grade 2 and 3 were defined as "meaningful coexisting spine lesions" (MCSL). Degenerative spinal diseases were classified into three pathologies: simple disc herniation, degenerative spinal stenosis, and ligament ossification disease. The relationships between MCSL, gender, age, and primary spine lesions were analyzed. RESULTS: MCSL were found in 95 patients: a prevalence of 31.1%. Five out of 95 MCSL were surgically managed. The most common types of MCSL were disc herniation with 13.1% prevalence, followed by degenerative stenosis (9.5%) and ligament ossification diseases (6.8%). Older patients (age > or = 40) showed a significantly higher prevalence of MCSL than younger patients. There was no significant difference between male and female patients. The prevalence of MCSL was significantly higher (52.4%) in ligament ossification diseases than in disc herniation or spinal stenosis. CONCLUSION: Degenerative spinal diseases showed a high prevalence of MCSL, especially in old ages and ligament ossification diseases. WSST2I is useful for diagnosing coexisting spinal diseases and to avoid missing a significant cord-compressing lesion.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Intervertebral Disk Displacement/diagnosis ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Prevalence ; Spinal Diseases/classification/*diagnosis ; Spinal Stenosis/diagnosis ; Young Adult

Although the Codman-Hakim programmable valve is one of most popular shunt systems used in the clinical practice for the treatment of hydrocephalus, malfunctions related with this system have been also reported which lead to underdrainage or overdrainage of the cerebrospinal fluid. While obstruction of the ventricular catheter by tissue materials or hematoma and catheter disconnection are relatively common, the malfunction of the valve itself is rare. Herein, we report on a rare case of shunt overdrainage caused by displacement of the pressure control cam after pressure adjustment. A 57-year-old female, who underwent a ventriculoperitoneal shunt eight years ago, experienced aggravating symptoms of shunt overdrainage after pressure adjustment. Displacement of the pressure control cam was revealed on the X-ray, and a shunt revision was performed. The purpose of this report is to provide a working knowledge of the valve structure and to enhance the ability to interpret the valve setting on an X-ray for diagnosis of valve malfunction.
Catheters ; Cerebrospinal Fluid ; Cerebrospinal Fluid Shunts ; Diagnosis ; Equipment Failure ; Female ; Hematoma ; Humans ; Hydrocephalus ; Middle Aged ; Ventriculoperitoneal Shunt

Chromoblastomycosis is a chronic subcutaneous mycotic infections caused by dermatiaceous fungi. Clinically, chromoblastomycosis presents frequently with erythematous or nodular plaque. In Korea, 10 cases of chromoblastomycosis have been reported and Fonsecaea pedrosoi is the most common agent. A 61-year-old woman who was diagnosed as chronic inflammatory demyelinating polyneuropathy 3 years ago, and had been treated with systemic corticosteroids and azathioprine, presented with pruritic, scaly erythematous plaques on the right forearm for 3 years. She had no history of trauma. Histological examination showed pseudoepitheliomatous hyperplasia, mixed granulomatous inflammatory cell infiltrate and multinucleated giant cells with sclerotic cells in the dermis. Tissue culture showed slowly growing, dark brown, velvety colony. DNA was extracted from the cultured colonies and the DNA sequence of the internal transcribed spacer (ITS) region of the clinical sample was matched for that of Fonsecaea monophora. The patient was treated with local heat therapy and topical terbinafine application.
Adrenal Cortex Hormones ; Azathioprine ; Base Sequence ; Chromoblastomycosis* ; Dermis ; DNA ; Female ; Forearm ; Fungi ; Giant Cells ; Hot Temperature ; Humans ; Hyperplasia ; Korea ; Middle Aged ; Polyneuropathies