A giant abdominal aortic aneurysm (AAA) renders surgical treatment much more difficult by deforming the proximal infrarenal aortic neck (shortened length and disturbed angulation), by altering the iliac arteries (marked tortuosity and aneurysmal dilatation), and by displacing abdominal organs. Because the retroperitoneal rupture of giant AAA makes the mesentery more elongated and deformed, compromising its blood flow and thus increasing the risk of mesenteric ischemia such as colon ischemia. We describe here the surgical repair of a large infrarenal AAA with a ruptured huge left common iliac artery aneurysm of 13.5 cm in diameter, accompanied by colostomy due to colon ischemia which occurred during the operation. We discuss the pathophysiology and preventive strategy of colon ischemia during ruptured giant AAA repair.
Aneurysm* ; Aneurysm, Ruptured ; Aortic Aneurysm, Abdominal ; Colitis, Ischemic ; Colon* ; Colostomy ; Iliac Artery ; Ischemia* ; Mesentery ; Neck ; Rupture

BACKGROUND: The proliferation of vascular smooth muscle cell(VSMC) is a part of the major pathogenic mechanism for atheroscle- rosis. It has been reported that L-type calcium channel plays a role in the VSMC proliferation in diabetic rats. But there is a little study results about the association between L-type calcium channel and VSMC proliferation by glucose concentrations in culture media. So we examined the association between voltage-dependent L-type calcium channel of VSMCs and the proliferative activity of vascular smooth muscle cells. METHODS: Rat aortic VSMCs were isolated from the aorta of OLETF rat by enzyme method. VSMCs were cultured in various concentrations of glucose(5.5, 25 mM). The VSMCs(1x104 cells in 24-well plates) were incubated in the presence of Bay K 8644 (10-6M) with/without verapamil(10-6M) for 48 hours. Then the proliferation was assessed by MTT(methylthiazole tetrazolium) assay and expression of L-type calcium channel mRNA was measured by RT-PCR. RESULTS: The proliferative ability and the expression of L-type calcium channel of cultured VSMCs were increased dose-dependently by the glucose concentrations(p<0.05). Bay K 8644 enhanced the proliferation of VSMC and verapamil blocked the incremental effects induced by Bay K 8644. CONCLUSION: These results suggest that L-type calcium channel may play a role in VSMC proliferation of OLETF rat.
3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Animals ; Aorta ; Calcium Channels, L-Type* ; Cell Proliferation* ; Culture Media ; Glucose* ; Muscle, Smooth, Vascular* ; Rats ; Rats, Inbred OLETF* ; RNA, Messenger* ; Verapamil

No abstract available.
Peptic Ulcer*

Thirty one free vascularized fibula bone grafts were performed for treatment of osteonecrosis of the femoral head in 26 patients, 24 men and 2 women aged from 16 to 48(mean:32 years). Twenty one patients had unilateral disease. Five patients had bilateral disease underwent staged bilateral free vascularized fibula grafts three months apart. Associated etiological factors included alcohol(9 patients), steroid(7 patients), and trauma(one patient). The condition was considered idiopathic in the remaining 9 patients. Radiologic staging by Ficat included stage 1 in one hip, stage II in 15 hips, stage III in 14 hips, and stage IV in one hip. A skin island flap was used for monitoring purpose for the grafted fibula. One monitoring, flap was necrotized due to vascular occlusion but the fibula bone graft was left in place to use as a nonvascularized bone graft. Average follow-up period was 21 months in 31 hips. Pain was relieved in 28 hips(93.3 percent) and aggravated in 2 hips(6.7 per cent). On radiographic evaluation, 26 hips(86.7 per cent) demonstrated excellent preservation of the femoral head contour. Progressive collapse of the femoral head (greater than 1-2 mm) occurred in 2 hips, i mm depression in one hip with stage III and 2 mm collapse in one hip with stage IV. In conclusion, the free vascularized fibula bone graft is an excellent treatment modality for preserving the femoral head and relieving symptoms in cases of the osteonecrosis of the femoral head.
Depression ; Female ; Fibula* ; Follow-Up Studies ; Head* ; Hip ; Humans ; Male ; Osteonecrosis* ; Skin ; Transplants

The number of cancers in the head and neck areas has been increasing due to the increasing life span of the patients and a free flap is a common procedure to reconstruct defect in the head and neck area. From March 1990 to February 1998, 105 patients underwent 110 free flap operations after head and neck cancer ablation and they were reviewed retrospectively. Among 110 free flaps, 93 are forearm flaps, 6 jejunal flaps, 5 vascularized fibular osteocutaneous flaps, 2 lateral arm flaps, 2 rectus abdominis myocutaneous flaps and 1 latissimus dorsi muscle flap and 1 latissimus dorsi myocutaneous flap. Sixty-five radial forearm flaps and 4 ulnar forearm flaps were utilized in patched type and 24 radial forearm flaps in tubed type mainly for the reconstruction of intraoral and hypopharyngeal defects. Sis jejunal flaps were utilized for the esophageal reconstruction and 5 vascularized fibular osteocutaneous flaps for the mandibular reconstruction. The remaining flaps were for the reconstruction of other areas of head and neck.Overall survival rate of the flap was 95.5%. Immediate complications were fistula formation(3 cases), total flap loss (4 cases) or partial flap loss(3 cases) and donor site problems(10 cases). Superior thyrodial artery was the most commonly used recipient artery(89 cases) which was followed by facial artery, lingual artery and transverse cervical artery. Size discrepancy was not remarkable between the donor and recipient arteries. However, there was usually a marked size discrepancy between donor and recipient veins. More than two venous anastomoses were performed to increase the success rate of the flap surgery. An average follow-up period was 38 months ranging from 3 months to 6 years. There was no patient who died during or right after the operations, but 23 patients died due to recurrence of tumors or underlying heart disease during the follow-up period. Remaining patients lived well excluding 6 late postoperative complications such as 4 cases of esophageal stenosis and 2 cases of osteoradionecrosis. We conclude that free flap reconstruction after head and neck cancer ablation improves the quality of life and minimizes the loss of function.
Arm ; Arteries ; Esophageal Stenosis ; Fistula ; Follow-Up Studies ; Forearm ; Free Tissue Flaps* ; Head and Neck Neoplasms* ; Head* ; Heart Diseases ; Humans ; Mandibular Reconstruction ; Myocutaneous Flap ; Neck ; Osteoradionecrosis ; Postoperative Complications ; Quality of Life ; Rectus Abdominis ; Recurrence ; Retrospective Studies ; Superficial Back Muscles ; Survival Rate ; Tissue Donors ; Veins

The purpose of this study was to investigate the possibility of distraction osteogenesis in membranous onlay bone graft on the mandible and to clarify the histology of bone repair during distraction osteogenesis in the membranous onlay bone in a dog model. Four dogs, 5 months of age at the beginning of the experiment, were used for this study. The zygomatic arch was exposed in the subperiosteal plane and the full-thickness zygomatic arch was harvested to 3 centimeters in length. The lateral surface of the mandibular body was exposed in the subperiosteal plane and the membranous onlay bone graft was performed with firm contact using screws. The osteotomy on the membranous onlay bone graft and underlying mandibular body was carried down week 1 in dog 1, week 2 in dog 2, week 3 in dog 3, and week 4 in dog 4 after membranous onlay bone graft. The external distraction device was applied to the mandibular body. Mandibular distraction was started 7 days after the operation at a rate of 1mm per day for a total of 10 mm distraction over 10 days. After completion of distraction, the distraction device was left in place for 6 weeks bony consolidation of the distracted area. Radiographs were carried out at 2 weeks, 4 weeks and 6 weeks after distraction. New bone between the native underlying mandibular segments was generated in the distracted zone in all dogs. The new bone between the native underlying mandibular segments was generated in the distracted zone in all dogs. The new bone between segments of membranous onlay bone graft was not generated in dog 1, but it was generated in dogs 2, 3 and 4. However, in dog 2 and 3, the new bone between segments of the distracted membranous onlay bone graft presented less firmness with fibrous tissue than that of the native underlying mandibular segment. Histologically, the distracted gap between segments of the membranous onlay bone graft was composed of much fibrous tissue in the central zone while activated osteoblastic cells formed new bone in the margins of the distracted gap in dogs 2 and 3. In dog 4, there were abundant osteoblastic activities in the distracted gap and the new bone appeared as nearly-normal cortical bone. In conclusion, these findings suggested that membranous onlay bone graft had an osteogenic capacity and that distraction osteogenesis was possible in membranous onlay bone graft.
Animals ; Dogs* ; Inlays* ; Mandible ; Osteoblasts ; Osteogenesis, Distraction* ; Osteotomy ; Transplants* ; Zygoma

BACKGROUND: In women, the prevalence of depression is known to be more than twice as high as in men. Because many depressive women complain of their somatic symptoms instead of neurovegetative ones, many cases of depression have been misdiagnosed. Women also tend to use medicine more frequently than men do to manage depression. So we investigated the relationship between somatic symptoms and drug use in housewives for better management. METHODS: From 1st. March to 31st. March in 1996, the prepared questionnaires were presented to housewives living in the area of Kyung-ju city, who responded the questionnaires under direct interview. The questionnaire was composed of two parts. One part included demographic data, somatic complaints, drug use, places of drug purchase, current diseases that had been diagnosed by doctors. The other included Korean standard Beck Depression Inventory-questionnaire. The subjects were divided into two groups by BDI score(21 point), which was the cut-off point for depression in Korea. The relationships of somatic symptoms and drug use between the two groups were analyzed. RESULTS: There were 110 housewives who had depressive trends among 569 respondents. In general characteristics, there was significant difference between the two groups except the item of religion. In the items of somatic symptoms, there were more somatic symptoms in the group of high BDI score(>_21) except fatigue(P<0.01). More drug users were found in the group of high BDI score(>_21) (P<0.05). In the group of high BDI score(>_21), there was definite correlation between the items of somatic symptoms and drug use. There was no difference between the two groups in the item of drug purchase site. The most common site of drug purchase was the drug store in both groups. CONCLUSIONS: Depressive housewives complained of more somatic symptoms and more often used drugs as well.
Surveys and Questionnaires ; Depression ; Drug Users ; Female ; Gyeongsangbuk-do ; Humans ; Korea ; Male ; Prevalence

No abstract available.
Child ; Child Development* ; Humans ; Infant* ; Mass Screening*

PURPOSE: We performed this study to compare T1-201 and Tc-99m MIBI scans for the differentiation of malignant from benign breast mass. MATERIALS AND METHODS: Thirty-eight female patients underwent T1-201 breast scan and thirty-two of them also underwent Tc-99m MIBI scan of the breast. After intravenous injection of 74-111 MBq of T1-201, early (10 minutes) and delayed (3 hours) images were obtained. Then, 555-740 MBq of Tc-99m MIBI was injected and images after 30 minutes were obtained. We compared T1-201 and Tc-99m MIBI scans with pathologic RESULTS. RESULTS: Twenty-three patients were confirmed to have infiltrating duct carcinoma and fifteen patients to have benign breast mass by excisonal biopsy. The sensitivity of early and delayed T1-201 scan and Tc-99m MIBI scan in the detection of malignant breast lesion were 100% (23/23), 82% (18/22), and 90% (18/20), respectively. The specificity of early T1-201 scan was significantly higher than that of delayed T1-201 scan (p<0.05). The specificity of early and delayed T1-201 scan and Tc-99m MIBI scan were 73% (11/15), 73% (11/15) and 83% (10/12), respectively (p:not significant). Three patients out of nine with fibroadenoma and one patient with atypical duct hyperplasia were false positive in both early and delayed T1-201 scans. The size of fibroadenoma with false positvie in early and delayed T1-201 scan (4 cases) was larger than that of 11 fibradenoma with true negative scan (p<0.01). Metastatic axillary lymph node involvement was present in fifteen patients. The sensitive to detect metastatic nodes was 38% (5/13) for early T1-201 images, 15% (2/13) for delayed T1-201 images, 58% (7/12) for Tc-99m MIBI planar images and 67% (4/6) for Tc-99m MIBI SPECT. The sensitive of Tc-99m MIBI planar or SPECT was significantly higher than that of delayed T1-201 images (p<0.05). CONCLUSION: Early T1-201 and Tc-99m MIBI scan are useful noninvasive methods to differentiate malignant form benign mass of breast. Tc-99m MIBI scan was sensitive in detecting axillary lymph node metastasis in patients with brease cancer.
Biopsy ; Breast Neoplasms ; Breast* ; Diagnosis, Differential* ; Female ; Fibroadenoma ; Humans ; Hyperplasia ; Injections, Intravenous ; Lymph Nodes ; Neoplasm Metastasis ; Radionuclide Imaging ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

The incidence of tinea capitis was the least in the middle of 1970s, and thereafter it has been msrkedly increased along with other superficial mycoses due to Microsporum cania This study was to investigate the recent clinical and mycological trends of tinea capitis among the individuals of both out-patients of dermatologic clinic and orphanage children. These study data were compiled from 47 out-patients, which consisted of 31 patients from St. Pauls Hospital from September, 1980 to August, 1981 and 16 from St. Marys Hospital and Kangnam St. Marys Hospital from February to May in 1981, and from 79 patients of the orphage located in Seoul area in May, 1981. The results were as follows: 1. M. canis was isolated from all 47 out-patients with tinea capitis(male: 21, female 26). In orphanage, from 50 patients(63.3%) among the 79 patients with tinea capitis, 46 strains(92%) of T. ferrugineum from 30 male and 16 female patients, 3(6%) of M. canis from 3 males, and 1(2%) of T. violaceurn from a female were isolated. 2. The incidence of tinea capitis by M. canis in a total 5, 340 out-patients was 0. 58% (0. 62% in male, 0.56% in female) and its monthly distribution was almoat even through the studied period. The male to female ratio was 1:1,24, being more prevalent in female. 3. The age of onset was younger in female with tinea capitis due to M. canis than in male: The median age of onaet was 5 years in female and 7 years in male. In the group below 7 years of age, the maIe to female ratio was 1:1.84 and in the group above 8 years of age, l.74: 1.4. Most lesions of tinea capitis due to M. canis from out-patients showed multiple round grey scaled patches with shrotened hairs or round erythematous scaled alopetic patches. Kerion celsi were found in 4(9%) out of 47 out-patiente. Tinea corporia was combined in 4(9%) out-patients. There were domestic animals shch as kit or dog in 7(29%) among 24 houses of the patients.
Age of Onset ; Animals ; Animals, Domestic ; Child ; Dogs ; Female ; Hair ; Humans ; Incidence ; Male ; Microsporum ; Mycoses ; Orphanages ; Outpatients ; Seoul* ; Tinea ; Tinea Capitis