PURPOSE: The purpose of this study was 1) to find nerve damage after inferior alveolar nerve transposition and 2) to examine whether the soft tissue or bone changes around the nerve produce the compression to the nerve in the healing period. MATERIALS AND METHOD: Inferior alveolar nerve was exposed through the bony window and the scratch was made in the bone to be thought as the inferior alveolar canal. Suture was made after the nerve was repositioned. The nerve and surrounding tissues were examined with the light microscope and the fluorescent microscope before surgery and at 1 month, 3 months, and 5 months after surgery. RESULTS: After surgery, the epineurium was damaged and the nerve was divided to several fascicles covered with the perineurium The newly formed fibrous connective tissue and vessels were seen around fascicles. There was new bone formation. However the nerve was not compressed by the connective tissue or the new bone. CONCLUSION: The results of this study suggest that neurosensory disturbances after inferior alveolar nerve transposition are resulted by the direct trauma in surgery rather than the compression to the nerve by the scar or new bone formation in the healing period.
Cicatrix ; Connective Tissue ; Mandibular Nerve* ; Osteogenesis ; Peripheral Nerves ; Rabbits* ; Sutures

No abstract available.
Acidosis* ; Diagnosis*

BACKGROUND: Compared with conventional routes of delivering potent analgesics to postoperative patients, transdermal administration of fentanyl offers the advantages of simplicity and noninvasiveness. The analgesic efficacy and safty of transdermal fentanyl patch (TDFP) were evaluated postoperatively. METHOD: TDFP releasing 25 mcg/hr (Group 1) or placebo (Group 2) were applied to 40 women 6 hours before total abdominal hysterectomy under the general anesthesia. Postoperatively, self-administered intravenous fentanyl was maintained with a 20-mcg incremental dose and a 10-min. locking interval. Each group was assessed following 48 hours with respects to vital signs, VAS pain scores, hourly-used fentanyl doses, satisfaction scores and side effects. RESULT: VAS observed 24 hours, 36 hours after operation were significantly lower in group 1 than group 2. Hourly-used fentanyl doses were significantly lower in group 1 than group 2 at 2 hours, 6 hours, 12 hours and 24 hours after operation. The incidence of side effects were similar between group 1 and group 2. CONCLUSION: TDFP-25 mcg applied 6 hours before operation provides supplementary analges-ia after the postoperative period without significant side effects such as respiratory depression.
Administration, Cutaneous ; Analgesics ; Anesthesia, General ; Female ; Fentanyl* ; Humans ; Hysterectomy* ; Incidence ; Postoperative Period ; Respiratory Insufficiency ; Vital Signs

No abstract available.

Early treatment to facilitate the muscular blood flow can avert myonephropathic metabolic syndrome (MNMS) and major amputation for patients suffering with acute limb ischemia. Delayed reperfusion or microemboli in the small vessels can aggreviate: ischemic changes and lead to irreversible muscle necrosis. Amnion is an excellent biological dressing, and we tried using it to treat anterior compartment muscle necrosis (ACMN). The amnions were aseptically collected from caesarean sections. Additional betadine (1 : 3 solution) and vaseline-soaked gauzes were applied over the amnion as a daily biologic wet dressing. The amnion was replaced every three days. Finally, split skin grafting was performed on the healthy granulation tissue. We treated two patients who happened to have shin muscle necrosis. A 65-year-old man with a femoro-femoral arterial bypass showed graft thrombosis. Thirteen days after performing balloon angioplasty with stent insertion in the right femoral artery, new emboli were found in the stent and in the left popliteal artery. There was an attack of myocardial infarction the next day after embolectomy. The severe MNMS and ACMN at the right shin occurred after cardiopulmonary resuscitation. The dry gangrene was excised 3 months later, and this was followed by a skin graft 4 months later. An 81-year-old woman with atrial fibrillation showed left common femoral arterial obstruction and ACMN on the left shin during the management of congestive heart failure. The dry gangrene was excised 2 months later, and this was followed by a skin graft 3 months later. The amnion dressing shows promises for providing healthy granulation tissue for split skin grafts when treating muscle necrosis of the leg. Biologic dressing with using amnion is an option for limb salvage in the case of muscle necrosis that is caused by acute limb ischemia, although the treatment takes a long time.
Aged ; Aged, 80 and over ; Amnion* ; Amputation ; Angioplasty, Balloon ; Atrial Fibrillation ; Bandages* ; Biological Dressings ; Cardiopulmonary Resuscitation ; Cesarean Section ; Embolectomy ; Extremities* ; Female ; Femoral Artery ; Gangrene ; Granulation Tissue ; Heart Failure ; Humans ; Ischemia* ; Leg ; Limb Salvage ; Lower Extremity* ; Myocardial Infarction ; Necrosis* ; Popliteal Artery ; Povidone-Iodine ; Pregnancy ; Reperfusion ; Skin ; Skin Transplantation ; Stents ; Thrombosis ; Transplants

BACKGROUND: Several clinical studies reported the efficacy of the long-acting SRIH analog, octreotide (Octreotide, Sandoz) in the treattnent of acromegaly. Recently, another SRIH analog (BIM 23014, Ipsen Biotech) was shown to decrease plasma GH levels in acromegalic patients. The recent availability of a long-acting formulation of BIM 23014 [slow release (SR) lanreotide] could avoid repeated sc injections or continuous sc infusions. The objective of this study was to determine the tolerability and effectiveness of the slow release (SR) somatostatin analog, SR lanreotide in active acromegaly. METHOD: Between March 1998 and May 1998, 10 patients were recruited in the prospective study carried out at Yonsei University. The effects of 6 weeks of SR lanreotide, given every 14 days at a dosage of 30 mg, im, were analyzed. All the patients completed the 6-week period of therapy. RESULTS: SR lanreotide injection produced 45% suppression of area under the curve of GH levels from the basal value on oral glucose tolerance test(OGTT). GH values on OGTT were normalized (< 2ng/mL) in 30% of patients after 6 weeks, whereas insulin-like growth factor I (IGF-I) levels were normalized in 50% of patients. No correlation was found between pretreatment GH levels and GH response to SR lanreotide or between changes in GH and IGF-I during therapy, The significant differences in response to SR lanreotide were shown between the patients with residual mass and no visible mass. During treatment, there was the significant reduction in the percentage of patients complaining of joint pain, hyperhydrosis, and paresthesias. Changes in soft tissue swelling were documented by a significant decrease in the diameter of fingers. Mild diarrhea and fatigue were the most frequent side-effects (20 30%) when SR lanreotide therapy was started. However, these side effects decreased progressively. Significant changes were noted in carbohydrate tolerance. CONCLUSIONS: These data indicate that SR lanreotide at a dose of 30 mg, im, every 14 days is an effective treatment in most unselected acromegalic patients, especially in patients with no visible mass. Tolerability to SR lanreotide therapy is high. The use of a new sustained release formulation of somatostatin analog is clearly advantageous in improving patient compliance with medical treatment for acromegaly.
Acromegaly ; Arthralgia ; Diarrhea ; Fatigue ; Fingers ; Glucose Tolerance Test ; Humans ; Insulin-Like Growth Factor I ; Octreotide ; Paresthesia ; Patient Compliance ; Plasma ; Prospective Studies ; Somatostatin

No abstract available.

OBJECTIVE: To evaluate clinical usefulness of magnetic resonance angiogra phy(MRA) in the diagnosis of moyamoya disease. SUBJECTS AND METHODS: 14 moyamoya patients were included in this study. The machine was a Magnetom 63SP(Siemens) with a static magnetic field of 1.5T. MRA was performed by 3 dimensional time of flight(3D-TOF) method. Upon a total of 28 sides, the degree of stenotic process at the supraclinoid portion of internal carotid artery and the proximal portions of anterior cerebral artery and middle cerebral artery, and the number of moyamoya vessels(MMV) as well as presence of leptomeningeal anastomosis or transdural collaterals were evaluated. The findings of MRA were compared with those of contrast angiography(CA). RESULTS: 1) The degree of stenotic process : Among 28 sides, all but one were abnormal in both MRA and CA. Findings of MRA in the degree of stenosis were exactly correlated with those of CA in 24 sides(89.9%, 24/27) and the degree of stenosis was overestimated by MRA in 3 sides. 2) MMV : MRA visualized MMV in 19 of 27(70.3%) hemispheres, while CA showed basal MMV in 25(93.791) hemispheres. MRA underestimated the number of MMV in 9 hemispheres. 3) Of a total of 29 large leptomeningeal or transdural collateral vessels demonstrated by CA, 15(51.7%) were identified by MRA. CONCLUSION: MRA is considered to be an excellent screening test for the diagnosis of moyamoya disease. However, further studies with another methods or higher field strength machines should be necessary for enhancing diagnostic accuracy, since MRA in this study poorly visualized small-sized arteries such as MMV and other collateral circulations compared to CA.
Anterior Cerebral Artery ; Arteries ; Carotid Artery, Internal ; Collateral Circulation ; Constriction, Pathologic ; Diagnosis* ; Humans ; Magnetic Fields ; Magnetic Resonance Angiography* ; Mass Screening ; Middle Cerebral Artery ; Moyamoya Disease*

The displacement of an entire tooth into the adjacent anatomical area is an uncommon complication of a tooth extraction. We encountered a 23-year-old woman who had previously undergone surgery under local anesthesia to remove the lower third molar about 12 weeks prior and the upper third molar was extracted 2 days prior to visiting this hospital. Upon admission, she complained of a swallowing discomfort and a mouth opening limitation. Panoramic radiograph and a CT scan revealed a displacement of the entire tooth into the lateral pharyngeal space. The tooth was retrieved via the transoral approach under general anesthesia. The removed tooth had an indentation formed by a dental bur. Therefore, it was concluded that the tooth displaced into the lateral pharyngeal space was the lower third molar. This report describes an unusual case of a third molar that was displaced into the lateral pharyngeal space with a review of the relevant literature.
Anesthesia, General ; Anesthesia, Local ; Deglutition ; Female ; Humans ; Molar, Third* ; Mouth ; Tomography, X-Ray Computed ; Tooth ; Tooth Extraction ; Young Adult

No Abstract Available.