The authors report our experience of digital pulp reconstruction by free great toe pulp transfer. Twelve patients were treated with lateral great toe hemipulp. Twelve cases of digital pulp defect were reviewed, including 2 thumbs and 10 indices. There were 11 primary cases and 1 case of secondary reconstruction. We noted no necrosis and 5 patients suffered from cold intolerance. The flap sensibility, according to ASSH criteria, was excellent in 1 case, good in 10 cases, fair in 1 case and poor in no cases. The range of the stationary two-point discrimination test was between 4 and 15mm (mean S2-PD value; 7.2mm). The subjective evaluation found in 11 patients was satisfactory and dissatisfactory in 1. Performing this procedure during the acute phase may improve the management of trauma by reducing the time needed for cicatrisation and the length of disability. Furthermore, the principal advantages of this procedure are minimal donor site morbidity, as well as excellent functional and cosmetic gain.
Discrimination (Psychology) ; Humans ; Necrosis ; Thumb ; Tissue Donors ; Toes*

No abstract available.
Clonidine* ; Depression* ; Growth Hormone* ; Humans ; Panic Disorder* ; Panic*

Industrial exposure to toxic agent may produce a wide variety of respiratory damage. Acetic acid is a colorless liquid with a pungent vingar-like odor. It is a rare case that acute lung injury is caused by inhalation of acetic acid. Acetic acid is miscible with water, and may directly produce damage to mucosa of respiratory tract due to its irritant quality. The outcome of the reaction is dependent on the intensity and duration of exposure and varies from death or pulmonary edema in acute phase to resolution or bronchiolitis obliterans or bronchiectasis. We experienced a rose of acute lung injury due to accidental inhalation of acetic acid. The patient was a 31-year-old male who had developed progressive chest discomfort, chilling sense, and mild dyspnea after accidental inhalation of acetic acid. He had severe hypoxemia and chest radiograph showed diane bilateral alveolar edema. He responded to conservative treatment with oxygen inhalation and was discharged with improved condition on the 7th hospital day.
Acetic Acid* ; Acute Lung Injury* ; Adult ; Anoxia ; Bronchiectasis ; Bronchiolitis Obliterans ; Dyspnea ; Edema ; Humans ; Inhalation* ; Male ; Mucous Membrane ; Odors ; Oxygen ; Pulmonary Edema ; Radiography, Thoracic ; Respiratory System ; Thorax ; Water

The Dichloromethane(methylene chloride) is a highly volatile liquid used as a solvent, extraction medium, and paint remover. The most significant route of intoxication to dichloromethane is generally inhalation at work site or home, but ingestion is rare. The main toxicological harvard insults from in vivo conversion of dichloromethane to carbon monoxide. We present a case of dichloromethane intoxication following ingestion. A 71 years old male patient ingested 60-70cc of dichloromethane was brought to emergency department after stomach washout via nasogastric tube at other hospital. On arrival at emergency department(approximately 19 hours after ingestion), he was stuporous with a blood pressure 140/90mmHg, heart rate of 92 beats/min, dyspneic, respiratory rate of 24/min and body temperature 36.8 degrees C. His Pupils were isocoric, miotic, and sluggishly reactive. There were mucosal bums and significant secretion in oral cavity. On auscultation, breathing sound was coarse without role on both lung field. The COHb levels were 6.3%at 32 hours after ingestion and normalized to 0.6%at 44 hours after ingestion. Patient was transfered to intensive care unit and supportive care was started with 100% oxygen. On ingestion 4th day, chest X-ray showed pulmonary edema and acute respiratory distress syndrome developed. Patient regained the consciousness on the 11th day. On the 30th day, respiratory function improved and the ventilator was removed. Alveolitis and mild pulmonary fibrosis developed and mild dyspnea was continued. On the 36th day, gastroscopic examinations showed ulceration of esophagus and stomach. On the 76th day, patient was discharged after pulmonary rehabilitation.
Aged ; Auscultation ; Blood Pressure ; Body Temperature ; Carbon Monoxide ; Consciousness ; Dyspnea ; Eating* ; Emergencies ; Emergency Service, Hospital ; Esophagus ; Heart Rate ; Humans ; Inhalation ; Intensive Care Units ; Lung ; Male ; Methylene Chloride* ; Mouth ; Oxygen ; Paint ; Pulmonary Edema ; Pulmonary Fibrosis ; Pupil ; Rehabilitation ; Respiratory Distress Syndrome, Adult ; Respiratory Rate ; Respiratory Sounds ; Stomach ; Stupor ; Thorax ; Ulcer ; Ventilators, Mechanical ; Workplace

The dual muscle flap (Latissimus dorsi+ Serratus anterior muscle) based on the thoraco-dorsal vascular system for limb reconstruction has been infrequently reported. We have used this flap as a free flap for limb reconstruction in four patients (3 cases in lower linb, 1 in upper limb). A Latissmusi dorsi muscle or musculocutaneous flap and Serratus anterior muscle flap were used and all cases healed satisfactorily. The indications for this flap are to resurface two separate defects simultaneously or to resurface very large defects. It has the advantage of requiring anastomosis of one vascular pedicle only. This flap is particularly suitable for resurfacing defects wider than their length, in relation to the long axis of the limb.
Axis, Cervical Vertebra ; Extremities* ; Free Tissue Flaps ; Humans ; Myocutaneous Flap

Adenoma of the nipple is a benign tumor of the lactiferous ducts of the nipple which frequently causes erosion of the surface. It can clinically mmic Paget's disease and histologically be misdiagnosed as a well-differentiated adenocarcinoma. A 20-year-old woman developed an erythematous oozing patch on the right nipple two years ago, which subsequently developed iiito verrucous surfaccd papules. A biopsy specimen of the lesion showed focal acanthosis of the epidermis. The tumor was composed of fairly well-circumscribed, glandlike structures within the nipple stroma. Ductlike struciures, papillary areas, solid nests of cells and cysts lined by squarnous epithelium, could be seen, Two cell types lining the ducts were recognized; inner columnar cells and peripherally located cuboidal cells. Although simple excision of the adenoma is the treatment of choice, our case was treated successfully by electrucoagulation.
Adenocarcinoma ; Adenoma* ; Biopsy ; Epidermis ; Epithelium ; Female ; Humans ; Nipples* ; Young Adult

No abstract available.
Evaluation Studies as Topic* ; Hoarseness*

No abstract available.
Apocrine Glands ; Hidrocystoma*

No abstract available.
Nasal Bone*

BACKGROUND: It is important to evaluate the patient presenting with non-traumatic chest pain in emergency department, and it is also difficult to classify appropriately. The purpose of this study is to predict probability of acute myocardial infarction(AMI) and assess the group for low probability of AMI that is target for observation-unit of chest pain in emergency department. METHODS: A prospective, clinical study was performed from March 1998 to August 1998 at the department of emergency medicine, Ewha Womans University Mokdong hospital. We classified high-probability group and low-probability group of AMI according to Goldman's algorithm and then compared with the final diagnosis. RESULTS: The study included 218 patients. 84 patients(39%) was the high-probability group and 134 patients(61%) was the low-probability group of AMI. As compared with final diagnosis, AMI was 47 patients(56%) among the high-probability group and 1 patient(0.7%) among the low-probability group. We observed sensitivity of 98%, specificity of 78% in predicting AMI. CONCLUSION: The classification according to Goldman's algorithm may be useful predictor of AMI and improve triage for emergency department patient with chest pain. It is also helpful for management of observation-unit of chest pain in emergency department.
Chest Pain* ; Classification ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thorax* ; Triage