Island flaps have been widely used for the management of soft tissue defects in reconstructive surgery. The necrosis of the flap has been a catastrophe in clinical fields. It is well known that revascularization to the flap after ligation of its pedicle comes from the recipient bed and flap margins. The authors investigated the effects of the ischemic recipient bed on island flap survival after the ligation of its pedicle in the rats. One hundred and thirty inferior epigastric island flaps were divided into three groups (Group I, Group II, and Group III) according to the degree (0%,20%, and 60%) of interruption of contact of flap with the recipient bed, respectively. In Group I,the vascular pedicles were ligated before and on the 0, 2nd, 3rd, 4th and 5th days after flap elevation, and in Group II & III, the vascular pedicles were ligated on the 2nd, 3rd, 4th and 5th days after flap elevation. Flap survival was assessed on the 3rd day after pedicle ligation. Microangiographic studies were also performed on the 3rd day after pedicle ligation to study revascularization within the flap and the change of blood vessels around the flap margins. The results were as follows: 1. Flap survival was increased significantly in the flaps with pedicle ligation on the 4th and 5th postoperative days compared to those at the 2nd and 3rd postoperative days. 2. From the 3rd postoperative day, flap survival was not influenced significantly by the degree of limited bed contact and the date of pedicle ligation. 3. In spite of limited bed contact, the flap will likely survive with abundant revascularization from the flap margins. In conclusion, the flaps with limited bed contact were revascularized significantly from the flap margin by the 3rd postoperative day.
Animals ; Blood Vessels ; Ligation ; Necrosis ; Rats ; Surgical Flaps

Massive ovarian deema is a tate conditian. It is a benign enlargement of the ovary caused by accumulation of fluid, which is thought to result from intermittent partial toraion of the ovarian pedicle. Histologically, the ovaries were characterized by diffuse edema of medulla and inner cortex. Two cases of massive ovanan edema are reported with brief review of the literatures.
Edema* ; Female ; Ovary

PURPOSE: The purpose of this study was to analyze the flow signal chracteristics of 3 dimensional time of flight MR angiography (3D TOF MRA) by using a flow phantom model. MATERIALS AND METHODS: Nonpulsatile flow phantom and tap water were used in this experiment. We performed FISP 3D TOF MRA with various values of parameters (repetition time ; 34-100 msec, flip angle ; 10degrees-50degrees, flow velocity ; 14.7-73.6 cm/sec, Gd-DTPA concentration ; 0.6-3.6 mmol/liter). The values of flow signal intensity (SI), signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured from base images of each MRA. The measured values were displayed graphically and analyzed statistically in relation to various parameters. RESULTS: A prolongation of repetition time resulted in a decrease of CNR of flow. As flip angles increased, SNR and CNR of flow also increased but larger flip angles of more than 40degrees rapidly saturated exit flow. As the flow velocities increased in a range of 14.7-73.6 cm/sec, SNR and CNR of flow decreased. This may be related to the phase dispersion effect of laminar flow, more dominat than the TOF effect. The addition of Gd-DTPA to water increased SNR and CNR of exit flow. There were however, no significant differences of SI, SNR or CNR of flow among the various concentrations of Gd-DTPA. CONCLUSION: An experimental MRA study using a flow phantom model was useful in understanding the flow signal characteristics of 3D TOF MRA within various MRA parameters. Our preliminary results can be used as basic data for refined flow experiments.
Angiography* ; Gadolinium DTPA ; Noise ; Signal-To-Noise Ratio ; Water

Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary.

Traumatic hip joint dislocations account for 2–5% of total joint dislocations. Bilateral asymmetric hip joint dislocation with anteriorly and posteriorly dislocation is an even more rare case because it was according to G. Loupasis reported in 11 cases only since 1879. We want to report 2 cases of bilateral asymmetric hip joint dislocation with unilateral acatabulum fracture which happened in our hospital. Bilateral asymmetric dislocation of hip joint accompanied by unilateral fracture of acetabulum is a very rare case so statistical verification cannot be done. However, close examinations are required at early treatment and follow-up because the patterns of dislocation and fracture of hip joint are variable and an orthopedic emergent condition and several complications may occur at both hip joints.

The 302 patients with head-injured military personnel who had admitted to the Department of neurosurgery, Capital Armed Forces General Hospital were clinicostatistically analysed and discussed with the review of the literatures. The results were as follows: The most common cause of head injury was traffic accident(38.4% of the total cases) and the next were, in order of incidence, simple fall(9.5%), exercise(3.9%), assault(13.5%) and gun shot wound or explosive injury(7.2%). 2) Skull fracture was identified in 214 cases;98 cases of linear, 87 cases of depressed, 4 cases of basal, 2 cases mixed skull fracture. 3) The 85.7% of epidural hematomas were associated with skull fracture and the most common site of hematoma was frontal area. 4) Of all cases of subdural hematoma, acute type was prevalent(67.9%) and its main involved wite was frontotemporoparietal areas. 5) The associated injuries were found in 35.7% of patients. 6) The minor head injury of which GCS is from 13 to 15 was 148 cases, the moderate head injury of which GCS is fromn 9 to 12 was 49 cases, the severe head injury of which GCS is form 3 to 8 was 105 cases. 7) Of 105 cases of severe head injured patients the mortality was 61.9% and good recovery was 7.6%. But outcome was different according not only to GCS but also the type of lesion. 8) The operative morality was 24.1% and the good recovery was achieved 55.2% of patients. The remaining 8.9% resulted in disabled or vegetative state. 9) In the accidents of gun shot wound or explosive injury, operation mortality rate was 31.8%, but 8 cases(36.3%) were seen good recovery.
Arm ; Craniocerebral Trauma ; Glasgow Coma Scale ; Head ; Hematoma ; Hematoma, Subdural, Acute ; Hospitals, General ; Humans ; Incidence ; Military Personnel* ; Morals ; Mortality ; Neurosurgery ; Persistent Vegetative State ; Skull Fractures ; Wounds and Injuries

No abstract available.
Adenoma* ; Common Bile Duct*

This article describes methods used to produce a RBRVS (resource-based relative value scales), a common scale from two specialties (internal medicine and general surgery) and explains the newly developed extrapolation process within each specialty. To produce a common scale, we selected six 'same' services as linking services common to both specialties. Then we used the bi-weighted least squares method to locate all the same services on a single, common scale. By using the same method, we tried to extrapolate all the services within each specialty, not by the method of Kelly et al, dividing all the services within the specialty into families (small homogeneous groups of services) to apply charge-based ratios. To compare both methods, we extrapolated all the services of general surgery according to each method. With the correlation analysis to compare both results to American RVUs, we found that general surgery's RVUs from our own extrapolation method turned out to be more highly correlated with American RVUs than from Kelly's extrapolation method. Consequently, extrapolation with bi-weighted least squares method gave reasonable results.
Human ; *Internal Medicine ; Least-Squares Analysis ; *Relative Value Scales

BACKGROUND: Microemulsion propofol produces more frequent and severe pain upon injection than lipid emulsion propofol. This study examined the analgesic effect of lidocaine-premixed microemulsion propofol in patients pretreated with remifentanil. The induction of anesthesia with this combination was compared with microemulsion propofol accompanied with either remifentanil or lidocaine. METHODS: One hundred twenty patients aged between 20-65 years old were allocated randomly into one of three groups (n = 40, in each). The patients in the remifentanil group received remifentanil 0.5 microgram/kg IV for 30 seconds before a microemulsion propofol injection. The patients in the lidocaine group received propofol 2 mg/kg premixed with 40 mg lidocaine over a 60 second period. The patients in the combination group received both remifentanil and lidocaine. RESULTS: There was a significantly lower incidence of microemulsion propofol injection pain (severity 2 or more) in the combination group (12.5%) than in the remifentanil and lidocaine groups (90% and 65%, respectively, P < 0.05). The incidence of moderate pain disappeared completely in the combination group (0%) compared to that in the remifentanil and lidocaine group (32.5% and 20%, respectively, P < 0.05). Severe pain did not appear in any of the three groups. There were no complications on the injection site in the lidocaine alone and combination groups. CONCLUSIONS: The combination of microemulsion propofol premixed with lidocaine after a pretreatment with remifentanil was more effective in reducing the incidence of pain upon the injection of microemulsion propofol than either treatment alone.
Aged ; Anesthesia ; Anesthetics, Intravenous ; Humans ; Incidence ; Lidocaine ; Piperidines ; Propofol

Primary transitional cell carcinoma of the ovary is recently recognized, as one of the main types of ovarian carcinoma. Histologically, it is distinguished from malignant Brenner tumor only in the abscence of benign or proliferative Brenner tumor component. primary transitional cell carcinomas are more aggressive than malignant Brenner tumors. However, Primary transitional cell carcinomas have a better response to chemotherapy than other types of ovarian carcinomas. We report a case of primary transitional cell carcinoma presenting as both ovarian masses that developed in a 60-year-old woman with a brief review of literature.
Brenner Tumor ; Carcinoma, Transitional Cell* ; Drug Therapy ; Female ; Humans ; Middle Aged ; Ovary*