No abstract available.
Nifedipine* ; Vasopressins*

No abstract available.
Hemodynamics* ; Hepatocytes* ; Ischemia* ; Liver* ; Urokinase-Type Plasminogen Activator* ; Verapamil*

No abstract available.
Magnetic Resonance Imaging ; Malformations of Cortical Development*

OBJECTS: The authors analyzed the results of management outcomes for elderly subarachnoid hemorrhage patients(>65 y.o.) treated with conservative management, transcranial and endovascular surgery. METHODS: At the authors' institution between Jan. 1997 and Aug. 1999, 104 elderly patients were treated with either conservative management or surgical management including transcranial and endovascular surgery for intracranial aneurysms. The medical recordings and neuroimaging studies of the patients were reviewed retrospectively. RESULTS: Of the 104 patients, 90 percent of the patients were ruptured and 10% unruptured. Of the 93 patients with subarachnoid hemorrahge, 72% were in good neurological status (Hunt Hess grade I-III), 28% were in poor grade (H-H grade IV-V). Fifty one percent of the patients had a history of having other systemic illness including cardiovascular, endocrinologic and cerebrovascular disease. Ten patients of poor neurological grade were treated with conservative management. Ninety two patients were treated with transcranial surgery and 2 patients with endovascular surgery. The management outcomes of the good neurological grade (H-H grade I-III) patients with transcranial surgery was: Glasgow outcome scale (GOS) I-II 79%, GOS III 12%, GOS IV-V (death) 9%, and outcomes of the poor neurological grade (H-H grade IV-V) was GOS I-II 12%, GOS III 41%, GOS IV-V 47%. The major causes of mortality related to transcranial surgery were pneumonia, sepsis, vasospasm, acute myocardial infarction, and brain swelling. Two patients were treated successfully with endovascular surgery, and there was no death during follow-up. CONCLUSION: This reports documents more than 80% of good neurological SAH patients undergoing treatment either transcranial or endovascular surgery can expect good clinical outcomes. So, elderly patients with good neurological grade can benifits from aggressive surgical management.
Aged* ; Brain Edema ; Follow-Up Studies ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm* ; Medical Records ; Mortality ; Myocardial Infarction ; Neuroimaging ; Pneumonia ; Retrospective Studies ; Sepsis ; Subarachnoid Hemorrhage

PURPOSE: Nasal defect can be caused by excision of tumor, trauma, inflammation from foreign body reaction. Nose is located in the middle of face and protruded, reconstruction should be done in harmony with size, shape, color, and textures. We report various methods of nasal reconstruction using local flaps. METHODS: From March 1998 to July 2008, 36 patients were operated to reconstruct the nasal defects. Causes of the nasal defects were tumor(18 cases), trauma(11 cases), inflammation from foreign body reaction(5 cases) and congenital malformation(2 cases). The sites of the defects were ala(22 cases), nasal tip(8 cases) and dorsum(6 cases). The thickness of the defects was skin only(5 cases), dermis and cartilagenous layer(7 cases) and full-thickness(24 cases). According to the sites and thickness of the defects, various local flaps were used. Most of alar defects were covered by nasolabial flaps or bilobed flaps and the majority of dorsal and tip defects were covered by paramedian forehead flaps. Small defects below 0.25cm2 were covered with composite graft or full-thickness skin graft. RESULTS: The follow-up period was 14 months. Partial flap necrosis was observed in a case, and one case of infection was reported, it was improved by wound revision and antibiotics. Nasal reconstruction with various local flaps could provide satisfactory results in terms of color and texture match. CONCLUSION: The important factors of nasal reconstruction are the shape of reconstructed nose, color, and texture. Nasolabial flap is appropriate method for alar or columellar reconstruction and nasolabial island flap is suitable for tip defect. The defect located lateral wall could be reconstructed with bilobed flap for natural color and texture. Skin graft should be considered when the defect could not afford to be covered by adjacent local flap. And entire nasal defect or large defect could be reconstructed by paramedian forehead flap.
Anti-Bacterial Agents ; Dermis ; Follow-Up Studies ; Forehead ; Foreign Bodies ; Foreign-Body Reaction ; Humans ; Inflammation ; Necrosis ; Nose ; Skin ; Succinates ; Transplants

OBJECTIVE: The goal of this study is to evaluate the surgical outcome of multiple aneurysms including distal anterior cerebral artery (DACA) aneurysms. MATERIAL AND METHOD: From May 1989 to March 2000, 12 patients with multiple aneurysms including DACA aneurysms, presented with subarachnoid hemorrhage, had been surgically treated. Their medial record and radiological studies were studied retrospectively. Of 12 patients, in 5 patients, all of the aneurysms were clipped through a single craniotomy extended from midline to pterion in one stage, in 5 patients, multiple aneurysms were treated through separate craniotomies in one stage and 2 patients were treated in staged operation. RESULTS: Two patients showed Glasgow Outcome Scale (GOS) 5-4, 2 patients showed GOS 3-2 and 1 patient showed GOS 1 in 5 patients treated through a single craniotomy in one stage, 2 patients showed GOS 5-4 and 3 patients showed GOS 3-2. All patients treated in staged operation showed favorable outcome. CONCLUSION: In surgical management of multiple aneurysms including DACA aneurysms surgery through separate bony windows in two stages seemed to show more favorable outcome.
Aneurysm* ; Anterior Cerebral Artery* ; Craniotomy ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm* ; Retrospective Studies ; Subarachnoid Hemorrhage

OBJECTIVE: To access the risk factors of posterior cerebral artery(PCA) occlusion during endovascular treat-ment of basilar bifurcation aneurysm and importance of collateral circulation through posterior communicating artery(PCoA) after PCA occlusion, the authors review the results of 25 patients with basilar bifurcation aneurysms treated with Guglielmi detachable coils(GDCs). METHODS: Male to female ratio was 1: 3.2(6: 19) and the mean age of this group was 54. Nineteen patients were presented with subarachnoid hemorrhage, 1 patient had neurologic deficits of hemiplegia and dysarthria, and 5 patients had incidental aneurysms with headache and dizziness. All patients underwent GDC embolization and their clinical results were analyzed. RESULTS: Seven of nine patients who resulted in PCA occlusion had a collateral flow from the anterior circulation through PCoA. Six patients had a PCoA larger than 1mm and they had no symptoms of ischemia after PCA occlusion. One patient who had a PCoA with 0.53mm in diameter had transient ischemic symptoms. The PCA arouse from the aneurysm neck in seven patients, and six of them resulted in PCA occlusion. Four of five patients who had aneurysms with broad neck(<4mm) resulted in PCA occlusion. CONCLUSION: The aneurysm with either broad neck or PCA arising from the aneurysm neck have a high risk of PCA occlusion. After PCA occlusion, significant blood flow from anterior circulation through the PCoA larger than 1mm in diameter can minimize the ischemic result in PCA territories.
Aneurysm ; Collateral Circulation ; Dizziness ; Dysarthria ; Female ; Headache ; Hemiplegia ; Humans ; Ischemia ; Male ; Neck ; Neurologic Manifestations ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Risk Factors ; Subarachnoid Hemorrhage

PURPOSE: Mastectomy is one of the operative procedures of female to male transsexuals. It is aimed to excise all of breast tissues and to reconstruct male chest wall, areola, and nipple. Breast sizes are varied by developmental status and their hormonal therapy. There are several approaches for mastectomy. This study is aimed to suggest appropriate mastectomy methods according to breast size in the female to male transgenders. METHODS: We retrospectively analysed 46 patients of female to male transgenders. Breast size was categorized by their inner wear size. In A cup size, mastectomy was done with periareolar approach. In C cup size, inframammary fold approach subcutaneous mastectomy was performed. In B cup size, periareolar approach was used for grade A or B ptosis patient, and inframammary fold approach was choosen for the patient with grade C ptosis. RESULTS: Subcutaneous mastectomy was done through semicircular periareolar approach for 26 patients. There were 2 cases of major complications that should be corrected by hematoma evacuation. Circumareolar approach was used for 5 patients, and a case of nipple-areolar complex necrosis was observed. Two cases of another complications which were irregularity of breast and wound disruption could be corrected. Inframammary fold approach was selected for 15 patients. There was a case of wound disruption, so revision surgery whould be done. Four cases of breast irregularity was corrected spontaneously, and 2 cases of partial necrosis of nipple-areolar complex were corrected with secondary healing. Patient satisfaction score for periareolar, cicumareolar, and inframmammary fold approach were 4.5, 4.2 and 4.1, respectively. Some major and minor complications were observed, but satisfactory results could be secured. CONCLUSION: Semicircular periareolar incision looked adequate for A cup size patient, circumareolar incision was suitable for B cup size with grade A or B ptosis. In B cup size with grade C ptosis patient and C cup patients, inframammary fold incision looked suitable for optimal results.
Breast ; Female ; Hematoma ; Humans ; Male ; Mastectomy ; Mastectomy, Subcutaneous ; Necrosis ; Nipples ; Patient Satisfaction ; Retrospective Studies ; Surgical Procedures, Operative ; Thoracic Wall ; Transgender Persons

BACKGROUND: The radial forearm osteocutaneous free flap is considered to be the standard technique for penile construction. One year after their operation, most patients experience a softened phallus, so that they suffer from difficulties in sexual intercourse. In this report, we present our experience with phalloplasty by radial forearm osteocutaneous free flap, as well as an evaluation of the etiology and treatment of the softened phallus. METHODS: Between March 2005 and February 2010, 58 patients underwent phalloplasty by radial forearm osteocutaneous free flap. Most of their neophallus had been softened subjectively and among them, 12 patients who wanted correction were investigated. We performed repetitive fat injection, artificial dermis grafting, silicone rod insertion, and rib bone with cartilaginous tip graft. Physical examination, plain radiograph, computed tomography, bone scintigraphy, and satisfaction scores were investigated. RESULTS: Most of the participants' penises have been softened after phalloplasty, and the skin elasticity had been also decreased. On plain radiograph, the distal end of the bone was self-rounded; however, the bone shape of the neophallus had no significant interval changes or resorption. Computed tomography showed equivocal density of cortical bone. On bone scintigraphy, the bone metabolism was active at 3 months postoperatively, and remained active 9 years postoperatively. CONCLUSIONS: The use of a rib bone with cartilaginous tip graft could be an option for improvement of the softened phallus. Silicon rod insertion is also worth considering for rigidity of the softened phallus. Decreased rigidity due to soft tissue atrophy could be alleviated with repeated fat injection and artificial dermis grafting.
Atrophy ; Coitus ; Dermis ; Elasticity ; Forearm ; Free Tissue Flaps ; Humans ; Male ; Penis ; Physical Examination ; Postoperative Complications ; Ribs ; Silicones ; Skin ; Transplants

OBJECTIVE: Eleven patients treated with posterior cerebral artery(PCA) aneurysm during 6.3-years period are retrospectively reviewed to determine treatment outcome. METHODS: Eleven patients with PCA aneurysm were treated from January 1998 to May 2004. Their medical records and radiologic studies were reviewed retrospectively. The records of these patients were analysed with particular reference to their demographic details, mode of presentation, and treatment outcome. RESULTS: Of the 11 patients, 8 patients presented with symptoms related aneurysmal bleeding. Three patients had unruptured PCA aneurysms. Open or endovascular surgery was performed in 9 patients; None of these patients exhibited a third nerve palsy, visual field deficit, or hemiparesis at the time of presentation. Postoperatively, 2 made a good recovery, 2 had a moderate disability because of cerebral infarction after surgery, and 5 had a severe disability because of cerebral infarction after surgery. Of 2 conservatively treated patients, 1 was doing well but the other died as a result of brain swelling. CONCLUSION: The treatment of the PCA aneurysms is difficult regardless of the aneurysmal size, site, and treatment modality. All reasonable treatment to reduce the risk of associated morbidity should be considered.
Aneurysm ; Brain Edema ; Cerebral Infarction ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Medical Records ; Oculomotor Nerve Diseases ; Paresis ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Retrospective Studies ; Treatment Outcome ; Visual Fields