Distal foot defect is frequently encountered as an output site in high-tension electrical burn injuries, and proper treatment methods should be applied in order to achieve a properly-functioning foot. However, in distal foot defects around the metatarsal heads or metatarsophalangeal joints, conventional methods have not been ideal, replaced by such methods as secondary healing, amputation or skin graft because there was insufficient tissue in the distal foot and the general condition of the patient was unsuitable for distant or free flap surgeries. So, in order to establish convenient, promising methods for the reconstruction of distal foot defects in severe electrical burns, we classified the distal foot into four zones according to their blood supply and we defined or created ideal reverse flaps in each zone. From April 1996 to March 1999, we reconstructed 43 cases of distal foot defects in fourth-degree high voltage electrical burn wounds. In 19 cases of MP(medial plantar) zone injuries, we used reverse medial plantar island flap and in 5 cases of DP(dorsalis pedis) zone, we created a reverse dorsalis pedis island fascia flap, In 11 cases of P(peroneal) zone, we created reverse peroneal fascia flap and in 8 cases of I (intermediate) zone, we modified a reverse posterior tibial island flap, There was partial flap necrosis or grafted skin loss in five cases, but those were extremely minor problems and we successfully reconstructed distal foot defects in all 43 cases. In conclusion, proper reverse flaps according to the zone of the distal foot are ideal reconstructive methods because they provide good vascularization, sufficient tissue from the proximal parts and they require short operative time with relatively easy procedures.
Amputation ; Burns* ; Fascia ; Foot* ; Free Tissue Flaps ; Head ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Necrosis ; Operative Time ; Skin ; Transplants ; Wounds and Injuries

No abstract available.
Scalp*

No abstract available.
Cleft Lip* ; Congenital Abnormalities* ; Nose* ; Transplants*

No abstract available.
Humans ; Prothrombin Time* ; Prothrombin*

Several blood dyscrasias associated with clozapine have been well known to clinicians and potentially life threatening agranulocytosis has been widely reported. However, there is little report regarding incidence, progression and associated features of eosinophilia associated with clozapine. In clinical studies, the onset of eosinophilia usually occurs artier 3 to 5 weeks of treatment and rarely were cases fatal with medical complication. We report the first case of severe eosinophilia, bilateral pleural effusion, asicites, hepatitis and cholecystitis associated with clozapine that would be fatal. Eosinophilia occurred after 19 days of treatment with clozapine and all the clinical conditions improved along with interruption of clozapine treatment. It is suggested that eosinophilia may be more severe side effort than has ether been known and close hematologic monitoring should be done during early treatment of clozapine.
Agranulocytosis ; Ascites* ; Cholecystitis ; Clozapine ; Eosinophilia* ; Ether ; Hepatitis* ; Incidence ; Pleural Effusion*

OBJECTIVES: The attentional deficit is a core symptom in attention deficit hyperactivity disorder. The major brain areas related to attention are frontal and parietal lobes. Abnormalities of frontal and parietal lobes in attention deficit hyperactivity disorder have been reported in previous researches. But, most of the researches are based on comparing patients and controls while they are in resting condition. Further research on funtional changes related to performance of attentional task is needed to understand the attentional dysfuntion in attention deficit hyperactivity disorder. In this study, the localized functional changes of the brains related to attentional task in patients with attention deficit hyperactivity disorder and the differences of them between patients and normal controls were examined. Also the effect of the methylphenidate on functional changes related to attentional task in patients with attention deficit hyperactivity disorder was examined. METHOD: Quantitative electroencephalography (QEEG) was applied to examine the fuctional changes related to attentional task. Subjects of this study consisted of 20 patients with attention deficit hyperactivity disorder and 20 controls who were matched age, sex, handedness, intelligence. QEEG was recorded on eye open resting condition, and on performing computerized attentional task. In cases of patients, after taking of methylphenidate, QEEG was recorded on both conditions. RESULTS: 1)In attention test, normal controls had better scores in response time and variabilities of response time than those of patients with attention deficit hyperactivity disorder without taking methylphenidate. After taking medication, scores of omission, response time and variabilities of response time were significantly improved, comparing to scores without taking medication. No differences were recognized between the controls and patients with taking medication in scores of attention test. 2)In resting condition, spectral EEG revealed baseline activity levels of patients were significantly increased comparing to those of controls. 3)Analysis of delta wave revealed that amplitudes of controls were significantly elevated in parieto-occipital area during performance of attentional task. But in patients, localized activated area related to attentional task was not remarkable. 4)Theta activity of controls were significantly elevated in right frontal, right temporal, and both parieto-occipital areas during performance of attentional task. But in patients without taking medication, localized activated area related to attentional work was not remarkable. After taking medication, right frontal, right temporal, and both parieto-occipital areas were significantly activated. 5)Alpha activities of controls were significantly increased in parieto-occipital area during performance of attentional task, but those of patients without taking medication were increased in broad area. 6)Beta activities of controls were significantly increased in frontal area during attentional performance, but those of patients without taking medication were significantly increased in most of the brain areas. After taking medication, significantly increased activities related to attentional task were recognized in left frontal, and both temporal areas. Localized activated patterns similar to those of controls were recognized. CONCLUSION: Based on the results of this research, it is suggested that patients with attention deficit hyperactivity disorder have increased baseline brain activity. In controls, brains showed localized response to a attentional stimuli, and functional changes related to attentional stimuli were recognized in frontal, and parieto-occipital areas. But, patients failed in showing appropriate localized activated response to attentional stimuli. It is concluded that frontal and parieto-occipital areas have some deficit responsible for the attentional dysfunction of attention deficit hyperactivity disorder.
Attention Deficit Disorder with Hyperactivity ; Brain ; Electroencephalography ; Frontal Lobe ; Functional Laterality ; Humans ; Intelligence ; Methylphenidate ; Parietal Lobe ; Reaction Time

BACKGROUND: There have been controversies whether mitral valvular surgery is necessary in the patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting. The purpose of this study is to evaluate the long term clinical results of patients with moderate ischemic mitral regurgitation. MATERIAL AND METHOD: Between January 1992 and February 2005, 44 patients with moderate ischemic mitral regurgitation underwent coronary artery bypass grafting. Concomitant mitral valvular procedure was performed in 20 patients (group 1) and isolated coronary artery bypass grafting was performed in 24 patients (group 2). There were no significant difference between groups except cardiopulmonary bypass time (p<0.01). Postoperative follow up duration was 30.1+/-29.6 months and last follow up echocardiographic examination was performed at 21.2+/-28.0 months. RESULT: There was no difference in operative mortality between groups (group 1 vs group 2, 15.0% vs 8.3%, p=0.493). Grade of mitral regurgitation (0.81+/- 0.91 vs 1.50+/- 0.05, p=0.046) and reduction in regurgitation grade (1.75 +/-0.93 vs 0.70 +/-1.26, p=0.009) were different between two groups. But there were no significant differences in left ventricular ejection fraction (34.1+/-11.4% vs 41.6+/-12.9%), left ventricular end systolic volume (118.2+/-63.9 mL vs 85.6+/-28.1 mL), New York Heart Association functional class (2.1+/-0.2 vs 2.4+/-1.2) and 5 year survival rate (85+/-8% vs 82+/-8%). There was no risk factor for operative mortality and the only risk factor for late death was preoperative atrial fibrillation (p=0.042). There was no significant correlation between mitral valvular surgery and late death. CONCLUSION: Concomitant mitral valvular procedure in patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting had no significant positive effect on survival and ventricular function compared with isolated coronary artery bypass grafting. Prospective randomized study may be needed to evaluate the necessity of concomitant mitral procedure and to find more effective method for the improvement of ventricular function.
Atrial Fibrillation ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography ; Follow-Up Studies ; Heart ; Humans ; Mitral Valve Insufficiency* ; Mortality ; Risk Factors ; Stroke Volume ; Survival Rate ; Ventricular Function

BACKGROUND: There have been controversies whether mitral valvular surgery is necessary in the patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting. The purpose of this study is to evaluate the long term clinical results of patients with moderate ischemic mitral regurgitation. MATERIAL AND METHOD: Between January 1992 and February 2005, 44 patients with moderate ischemic mitral regurgitation underwent coronary artery bypass grafting. Concomitant mitral valvular procedure was performed in 20 patients (group 1) and isolated coronary artery bypass grafting was performed in 24 patients (group 2). There were no significant difference between groups except cardiopulmonary bypass time (p<0.01). Postoperative follow up duration was 30.1+/-29.6 months and last follow up echocardiographic examination was performed at 21.2+/-28.0 months. RESULT: There was no difference in operative mortality between groups (group 1 vs group 2, 15.0% vs 8.3%, p=0.493). Grade of mitral regurgitation (0.81+/- 0.91 vs 1.50+/- 0.05, p=0.046) and reduction in regurgitation grade (1.75 +/-0.93 vs 0.70 +/-1.26, p=0.009) were different between two groups. But there were no significant differences in left ventricular ejection fraction (34.1+/-11.4% vs 41.6+/-12.9%), left ventricular end systolic volume (118.2+/-63.9 mL vs 85.6+/-28.1 mL), New York Heart Association functional class (2.1+/-0.2 vs 2.4+/-1.2) and 5 year survival rate (85+/-8% vs 82+/-8%). There was no risk factor for operative mortality and the only risk factor for late death was preoperative atrial fibrillation (p=0.042). There was no significant correlation between mitral valvular surgery and late death. CONCLUSION: Concomitant mitral valvular procedure in patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting had no significant positive effect on survival and ventricular function compared with isolated coronary artery bypass grafting. Prospective randomized study may be needed to evaluate the necessity of concomitant mitral procedure and to find more effective method for the improvement of ventricular function.
Atrial Fibrillation ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography ; Follow-Up Studies ; Heart ; Humans ; Mitral Valve Insufficiency* ; Mortality ; Risk Factors ; Stroke Volume ; Survival Rate ; Ventricular Function

In an attempt to clarify the relationshop between left ventricular function and chronic obstructive pulmonary disease(COPD), systolic time intervals were measured in 79 control subjects and 60 patients with COPD who had no evidence of organic heart disease. The patients with COPD were divided into three groups based on the percent predicted forced expired volume in one second. Significant differences in pre-ejection period index(PEPI) and left ventricular ejection time index(LVETI) existed between the control subjects and the patients with the most severe lung disease(Group III). A highly significant difference in PEP/LVET existed between these two groups. The abnormalities of systolic time intervals demonstrated in these patients are characteristic of left ventricular dysfunction and indicate that left ventricular dysfunction is frequently present in patients with moderate obstructive lung disease.
Heart Diseases ; Humans ; Lung ; Lung Diseases, Obstructive ; Pulmonary Disease, Chronic Obstructive* ; Systole* ; Ventricular Dysfunction, Left ; Ventricular Function, Left

OBJECTIVE: This open prospective study was performed to investigate the long-term efficacy and safety of risperidone in the treatment-resistant patient with chronic schizophrenia who had completed a 8-week short-term trial. METHOD: Fourteen patients with treatment-resistant chronic schizophrenia(DSM-IV), who had been previously treated with at least two different kinds of typical antipsychotic drugs but with insufficient clinical effects or who experienced distressing extrapyramidal side effects, were evaluated over a 48-week risperidone treatment period. Efficacy was assessed by the PANSS and the CGI, and its safety by the ESRS and the UKU side effect rating scale. Both were assessed at 8-week intervals. RESULT: Nine(four males and five females) of the fourteen patients completed the study. Overall, PANSS score for the entire period showed an improvement when compared with the baseline state. The pronounced improvement in CGI severity was seen between the 8th and 16th week, continued until endpoint. Of fourteen patients, eleven(78.6%) patients showed at least a 20% decrease in total PANSS scores on endpoint analysis. Transiently-observed extrapyramidal side effects following medication were akathisia(n=3), bradykinesia(n=3), and sialorrhea(n=2). Early UKU side effects included; increased dream activity, sedation, amenorrhea, and concentration difficulty. These were common but transient with the exception of amenorrhea. Three of the four patients with amenorrhea did not resume menses throughout the study. CONCLUSION: These results suggest that risperidone is a safe antipsychotic drug with long-term efficacy against both the positive and negative symptoms in the treatment of treatment-resistant schizophrenia.
Amenorrhea ; Antipsychotic Agents ; Dreams ; Female ; Humans ; Male ; Prospective Studies ; Risperidone* ; Schizophrenia*