The high osteogenic potential in children can lead to the spontaneous regeneration of a significant bone loss, however, the site documented in the previous reports was limited to the diaphysis in long bones. We report an exceptional case of a spontaneous regeneration of the whole lateral malleolus, including epiphysis, physis, and metaphysic, after traumatic loss in a three-year-old boy. This case emphasizes the importance of attempts to save as much of the cartilaginous tissues and the periosteum as possible, which have a great osteogenic potential, in themanagement of open would in childrhood.
Child ; Diaphyses ; Epiphyses ; Follow-Up Studies ; Humans ; Male ; Metaphysics ; Periosteum ; Regeneration

BACKGROUND: Balloon mitral valvuloplasty is a favorable procedure as a therapy for mitral stenosis because it minimizes morbidity and shorten hospital stay compared with surgical mitral commissurotomy or mitral valve replacement. Recent reports about concomitant transesophageal echocardiography guide in addition to fluoroscopy suggest that transesophageal echocardiograpy can provide additional benefits during balloon mitral valvuloplasty especially in transseptal puncture, balloon positioning, evaluation of immediate result, and early detection of complications. We performed this study to identify the potential benefits of on-line transesophageal echocardiography guide during balloon mitral valvuloplasty. METHOD: We performed balloon mitral valvuloplasty under on-line transesophageal echocardiography guide in addition to fluoroscopy in 70 patients(male:14, female:56, mean age:44+/-13) with rheumatic mitral stenosis from May 1995 to May 1996. Thirty-two(46%) patients had atrial fibrillation. Included patients were symptomatic with more than NYHA class 2 symptom. Patients with mitral valve score more than 11 and mitral regurgitation more than 2/4 were excluded. Inoue balloons were utilized in all cases. RESULTS: The average mitral valve area increased from 0.9+/-0.2cm2 before valvuloplasty to 1.8+/-0.4cm2 after valvuloplasty(p<0.0001). The averagetransmitral pressure gradient measured by continuous wave Doppler decreased from 14+/-6mmHg before valvuloplasty to 5+/-2mmHg after valvuloplasty(p<0.0001), and the average left atrial pressure measured by catheterization decreased form 22+/-8 mmHg before valvuloplasty to 11+/-5mmHg after valvuloplasty(p<0.0001). The average procedure time was 64+/-22 minutes(ranged from 13 to 150 minutes) and the average fluoroscopy time was 19+/-15 minutes(ranged from 1 to 94 minutes). Two patients underwent surgery due to severe mitral regurgitation associated with papillary muscle rupture which developed after valvuloplasty. In one patient, transesophageal echocardiography detected pericaridal tamponade during the procedure and the transducer was quickly switched to transthoracic transducer to guide the pericardial puncture site. The pericardial tamponade was drained with pigtail catheter and the patient underwent balloon mitral valvuloplasty successfully a week later. Four patients were pregnant at the time of the valvuloplasty procedure and the valvuloplasty was successfully performed with minimal fluoroscopy time(1-3 minutes) without complications in all four patients. Five patients had thrombus in left atrial appendage, but the transesophageal echocardiography was useful in monitoring the ballon position during the procedure and the valvuloplasty was successfully performed without embolic complications in all five patients. CONCLUSION: The transesophageal echocardiography is a very useful guiding adjunct during balloon mitral valvuloplasty in transseptal puncture, balloon positioning, evaluation of immediate result, early detection of complications, and shortening fluoroscopy time especially in pregnant women.
Atrial Appendage ; Atrial Fibrillation ; Atrial Pressure ; Cardiac Tamponade ; Catheterization ; Catheters ; Echocardiography, Transesophageal* ; Female ; Fluoroscopy ; Humans ; Length of Stay ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Papillary Muscles ; Pregnant Women ; Punctures ; Rupture ; Thrombosis ; Transducers

BACKGROUND: Percutaneous mitral balloon valvuloplasty(PMV) is a good treatment modality for patient with mitral stenosis(MS). But it is considered relatively contraindicated in patients with left artrial thrombi because of high risk of embolism. Limitted studies have suggested the feasibility of PMV in patients with left atrial appendage(LAA) thrombi. This study was performed to evaluate the feasibility and safty of PMV in patients with LAA thrombi using Inoue balloon under the transesophageal echocardiographic (TEE) monitoring. METHOD: PMV was performed in 5 patients diagnosed as MS with LAA thrombi from October, 1995 to July, 1996. Four cases were female, and one case was male. Their mean age was 525(46-58years old). Two of them had history of cerebrovascular accident(CVA). The duration of anticoagulant treatment was 6-49 moths. All patients underwent PMV using Inoue balloon catheter under the TEE monitoring. RESULTS: EKG finding of all 5 patients were atrial fibrillation(Af). Their mitral valve score were 5-10(Mean score was 82). Transmitral mean pressure gradient was decreased from 14.62.1 to 5.82.0mmHg, and mitral valve increased from 0.840.43 to 1.720.19 after PMV. There was no procedure related complication. In 3 cases of them LAA thrombi diappeared in the follow up TEE. In two patients, the LAA thrombi were calcified and remained unresolved at the time of follow up TEE( 6month-and 12 month-F/U, eath). CONCLUSION: Although the reported number of PMV in patients with LAA thrombi is small in this study, we believe that, with special precaution and TEE monitoring, LAA thrombi is no longer an absolute contraindication to PMV.
Atrial Appendage* ; Balloon Valvuloplasty* ; Catheters ; Echocardiography ; Electrocardiography ; Embolism ; Female ; Follow-Up Studies ; Humans ; Male ; Mitral Valve ; Moths

No abstract available.
Reticulocyte Count* ; Reticulocytes*

No abstract available.
Reticulocyte Count* ; Reticulocytes*

BACKGROUND: To evaluate the influence of changes in mitral valve area (MVA) and left atrial pressure on pulmonary vein flow (PVF) we analyzed PVF with transesophageal echocardiography (TEE) before, after and one-year after percutaneous mitral valvuloplasty (PMV) in patients with mitral stenosis (MS) in sinus rhythm. METHODS: PMV was guided with TEE. Follow-up TEE was done about one year after PMV. MVA and transmitral mean gradient (TMG) were measured. Systolic velocity (S), diastolic velocity (D), atrial reversal velocity (AR), their time-velocity integral (S-TVI, D-TVI, AR-TVI) and their ratio (S/D ratio, S-TVI/D-TVI ratio were evaluated. RESULTS: The number of patients was twenty-two (F:20). The age was 39+/-9 years (range:26-64). Follow-up duration was 16+/-6 months (range:7-28). MVA increased from 0.9+/-0.2 cm2 to 1.9+/-0.3 cm2 after PMV and decreased to 1.7+/-0.3 cm2 on follow-up TEE significantly. TMG decreased from 15.4+/-4.3 mmHg to 5.5+/-1.9 mmHg after PMV and was 6.2+/-2.4 mmHg on follow-up. S increased significantly on follow-up at both pulmonary vein (PV). D increased on follow-up at left PV. S/D ratio increased on follow-up at both PV. AR increased on follow-up at both PV. S-TVI increased after PMV at left PV and increased on follow-up at both PV. D-TVI had no change. S-TVI/D-TVI ratio increased on follow-up at left PV. AR-TVI increased on follow-up at right PV. CONCLUSIONS: The main changes after PMV in patients with MS in sinus rhythm were increasing tendency in S, S-TVI, S/D ratio, S-TVI/D-TVI ratio and AR. And these changes were statistically significant on follow-up TEE rather than immediately after PMV.
Atrial Pressure ; Echocardiography* ; Echocardiography, Transesophageal ; Follow-Up Studies ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Pulmonary Veins

According to photothermolysis, the FPDL(flashlamp-pumped pulsed dye laser) treatment theoretically causes no epidermal damage, however, we have observed blister, crust and scars in clinical experiences, and we have also found that FPDL has limited effect on adults, specially, thick-skinned Asian people with rich melanin pigment. In order to explain these effects, we took biopsies and made a histologic observation and analyzed the results statistically. The biopsies were taken from 15 patients who received first treatment and stained with H&E and NBTC(nitroblue tetrazolium chloride). We measured epidermal melanin content, epidermal damage, vessel wall coagulation depth, RBC coagulation depth, mean vessel diameter and evaluated clinical results at post-treatment 6 weeks. The vessel diameter and darkness of lesion color were increased with ages. Complete vessel coagulation was restricted to small vessels. With increasing epidermal melanin content, epidermal damage increased accordingly. The clinincal results were enhanced with increasing coagulation depth of vessel walls, and deteriorated with increasing epidermal melanin content. The clinical result was not significantly correlated with RBC-coagulation depth or energy used. We observed that melanin pigments have an adverse effect on clinical results. The FPDL treatment can be a choice of treatment to children with light colored lesion, but has a limitation to Asian adults with rich melanin pigment. Therefore, repetitive treatment is necessary for improvement of clinical results.
Adult ; Asian Continental Ancestry Group ; Biopsy ; Blister ; Child ; Cicatrix ; Darkness ; Humans ; Lasers, Dye* ; Melanins

The role of the long head of biceps brachii tendon in the stahilization of the head of the humerus is a highly interesting issue in recent studies. But, it is not well understood. Congenital absence of biceps long head tendon ot the hilateral shoulder joint is very rare and on review of literatures, we could not find any case reported. We experienced one case which was confirmed by magnetic resonance imaging and arthroscopic examination of the shoulder, and report it with review of literatures.
Head* ; Humerus ; Magnetic Resonance Imaging ; Shoulder Joint* ; Shoulder* ; Tendons*

Since adult human skin can be grown in chernically defined medium without serum, the skin organ culture has gained a great interest as a method for studies concerning skin biology, pharmacology and toxicology. however, serum supplementation has extensively been used to improve the viahility of tissue culture. This study was undertaken to evaluate the effect of serum on the histologic changes ohserved during the organ culture of the normal human skin. The general architecture of the skin was well maintained for 6 days with or without seru. After then, fetal calf serum or autologous human serum was found to enhance the viability of the epidermis. A confluent layer of necrotic spinous ceils was ovserved earlier and more widespread without serum. The addition of serum had an impressive effect on epibolization. In the absenee of serum, the formation of the epibolus was not only minimal, but also, susceptible to degeneration, and no epibolus remained at 10 days rif incubation. No difference can be found between fetal calf serm and autologous human serum in the formation of the epibolus. There was no favorable effect of serum on the formation of new stratum corneum. The thickness of new straturn corneum increased in parallel with the number of parakeratatic cells, increasing most rapidly between 6 and 8 days of incubation. Parakeratosis was more prominent in the presence of serurn.
Adult ; Biology ; Epidermis ; Humans* ; Organ Culture Techniques* ; Parakeratosis ; Pharmacology ; Selective Estrogen Receptor Modulators ; Skin* ; Toxicology

The saccadic reaction times to the double-step stimuli were studied in three human subjects to ascertain the saccadic visual tracking characteristics. Responses to simple step and double-step target motions were measured where the target mode and stimulus durations were randomized. To measure the eye movement the Photo-electric Eye Monitor was constructed based on limbus tracking. The results indicate that observers represented two kind of responses (A-or B-type) depending upon the stimulus duration. The percentage of occurrances increased as the stimulus duration increased from 50 to 200 msec. When the subject responded to both target motions, the reaction time of the second saccade was shorter than that of the first. The successive visual information is to change continuously the reaction time or cancel the initial saccade. Our results revealed that parallel data processing characteristics of the visual tracking systems and the saccadic decision-makings are influenced by the temporal relationships.
Adult ; Eye Movements* ; Human ; Male ; Motion Perception* ; Reaction Time* ; Saccades* ; Visual Perception*