Traumatic loss of a finger in part or in which inevitably leads to significant functional deficit and a distortion in body image of the inflicted individual. The available reconstructive option in these circumstances have been toe to finger transfer using microsurgical technique, flap coverage after bone graft, and osteodistraction of the remnant finger. Each method carries advantages and drawbacks inherent in the technique, and generally requires long operative time and hospitalization. Furthermore, the postoperative results after such procedures can be said to be less satisfactory in aesthetic perspectives. Apart from the toe to finger transfer, not much can be sought in terms of functional recovery of the reconstructed part, For a long time finger prosthesis have been used as a replacement of the lost finger part, but it fails to deliver functional strength and tends to be dislodged rather easily. To overcome these shortcomings in the technique, an osseointegrated finger prosthesis has recently been devel-oped. Thumb, index and middle finger in 3 patients were reconstructed with this osseointegrated finger prosthesis. The procedure requires two procedures; the first stage involves placement of a titanium screw in the phalangeal or metacarpal bone proper, followed by fixation of an abutment onto the titanium screw 3 months after the primary operation. The skin surrounding the abutment is thinned out to minimize mobility of the prosthesis at this second stage of operation. After wound stabilization in 2-3 weeks, a custom-made silicone finger prosthesis is made and attached to the implanted abutment using super power magnets. The entire procedure requires 4 months up to the completion, but the procedures can be carried out on the outpatient basis under local anesthesia, not having to interfere with the daily activities of the patient. The aesthetic results with osseoperception have been found to be rewarding, and usual activity like a hand writing and typewriting have been possible. This alternative method could be used for finger reconstruction in cases of usual reconstructive surgery being impossible.
Anesthesia, Local ; Body Image ; Fingers* ; Hand ; Hospitalization ; Humans ; Operative Time ; Outpatients ; Prostheses and Implants* ; Reward ; Silicones ; Skin ; Thumb ; Titanium ; Toes ; Transplants ; Wounds and Injuries ; Writing

In order to appreciate the incidence of scabies, the authors conducted an observation of ll,848 cases of scabies in 152,254 outpatients at Chilgok Catholic Skin Clinic from January 1968 to December 1979 and the following results were obtained; The incidence of scabietic patients was 7.78% among total outpatients and the annual frequency increased progressively from 1972 (3.86%), showed maximal incidence in 1975(12. 35%), and thereafter decreased. In sexual distribution, males predominated over female 1.9: 1. In age distribution, 2nd and 3rd decades occupied 64 of total scabietic patients. The monthly distribution of total scabietic patients was highest in December (10.85%) and lowest in August (4.57%) but no seasonal variation was observed. Over half(54.9%) of 5,273 scabietic patients visited within 2 months after their infection. 1,031 cases(10.27%) of 10, 036 scabietic patients revealed the complications such as infection (5.04%), eczematization (3.37%) and nodule (1.86%).
Age Distribution ; Female ; Humans ; Incidence ; Male ; Outpatients ; Scabies* ; Seasons ; Skin

Sodium thiopental is a popular intravenous anesthetic that has been used extensively throughout the world. The rare adverse reactions to thiopental consist mainly of anaphylactic shock, bronchospasm, and local thrombophlebitis. The reported incidence of presumed anaphylactic reaction (Type l hypersensitivity) to thiopental are extremely rare. Although the mechanism of these adverse reactiona is unclear, the clinical features (generalized erythema, hypotension, edema and bronchspasm) are thought to result from massive discharge of histamine and other vasoactive substance from basophils and mast cells. Since such reactions are life threatening, they must be recognized immediately and the appmpriate treatment given. The successful management of anaphylaxis requires a thorough understanding of this syndrome and the application of therapeutic agents. The authors report a case of anaphylactoid response to thiopental in a 34 years old healthy male patient and briefly review the literature.
Adult ; Anaphylaxis ; Basophils ; Bronchial Spasm ; Edema ; Erythema ; Histamine ; Humans ; Hypotension ; Incidence ; Male ; Mast Cells ; Sodium ; Thiopental* ; Thrombophlebitis

It is generally conceded that vasectomy is one of the most reliable methods of birth control because the technique is relatively simple, and the complete obstruction of the pathway for spermatozoa. However, a lot of unexpected effects were found after vasectomy. The possibility that it may effect changes in the function and structure of the testis and epididymis, as it were the formation of the sperm granuloma and antisperm antibody has been an important consideration in the controversy. The fate of non-ejaculated spermatozoa is postulated by some authors that those are disappeared by a progress of dissolution and reabsorption in the epididymis, or by formation of the sperm granuloma. According to Choi and Kim`s report about the effects of the seminal vesiculectomy on the structure and function of the testis and epididymis in rats. The distribution ratio of the sperm granuloma formation was higher in group of vasectomy and seminal vesiculectomy than that of vasectomy only, which indicated that the seminal vesicle produces a certain substance which enhance the sperm to be dissolved and reabsorbed in the epididymis. Therefore, we have attempted to prove the true state of sperm-acrosome on the fine structure after vasectomy and seminal vesiculectomy. The results were as follows: 1. The acrosomal membrane appeared quite intact on the electron microscopic study. 2. The architecture of the nucleus remained unchanged. 3. There was no evidence of nuclear membrane discontinuities, nor widening of the subacrosomal space. 4. Seminal vesicle seems to have some destructive activity on the sperm-acrosome after vasectomy.
Acrosome ; Animals ; Contraception ; Epididymis ; Granuloma ; Male ; Membranes ; Nuclear Envelope ; Rats ; Seminal Vesicles ; Spermatozoa ; Testis ; Vasectomy*

Sparganosis is a parasitic infestation which is manifested principally in the cats or dogs, but many human infestations have not been reported uncommonly. In Korea, the reported cases of human sparganosis are more than 20 cases till now Moreover the urogenital infestation of sparganosis is rarely observed. We have experienced one case of sparganosis in scrotum, which would often be confused with the sperm granuloma.
Animals ; Cats ; Dogs ; Granuloma ; Humans ; Korea ; Scrotum* ; Sparganosis* ; Spermatozoa

BACKGROUND: Laryngeal mask airway (LMA) is a useful instrument for routine anesthesia. It permits spontaneous or positive pressure ventilation but its use in obstetric anesthesia has not been described. In this study, we evaluated the effectiveness and the side effects of the LMA during elective cesarean sections. METHODS: Institutional approval and patients' permission were obtained. One thousand sixty-seven patients scheduled for elective an cesarean section, that have been NPO for more than 6 (6-48) hours were evaluated. They were premedicated with an H2 receptor blocker (ranitidine 50 mg i.m.) 1 hour before the operation. They were anesthetized with penthotal sodium (3-4 mg/kg), vecuronium (1 mg/10 kg i.m.) and then a 3 or 4 LMA was inserted after the mask ventilation with 100% oxygen for 1 min. The cuff was inflated with air 15.3 +/- 2.6 ml. On auscultation, air entry was good in both lungs. Anesthesia was maintained by 50% oxygen in N2O with 0.7 - 1.0% enflurane. Analgesics (tramadol 30 mg i.v.) was given incrementally after delivery of the baby. Manual assisted ventilation was used throughout the procedure. The number of insertion attempts, cuff volume and the incidences of complications were evaluated. RESULTS: In 1051 patients, the LMA was inserted on the first attempt. In 16 patients more than 2 attempts were needed and change to endotracheal intubation were needed in 7 cases. The mean cuff volume was 15 +/- 2.6 ml at insertion and increased to 18.5 +/- 3.2 ml after removal. The average airway pressure was 20 cmH2O during positive pressure ventilation, above that pressure air leakage was detected in 16 cases. Complications noted were mild sore throat in 5 cases, and blood tinged after removal of LMA in 3 cases but gastric distention was not detected. No incidence of aspiration was noted. CONCLUSIONS: In this study, the LMA proved to be a useful tool for the management of patients presenting for elective an cesarian section. There is the remote possibility of aspiration which did not happen in our study.
Analgesics ; Anesthesia ; Anesthesia, Obstetrical ; Auscultation ; Cesarean Section* ; Enflurane ; Female ; Humans ; Incidence ; Intubation, Intratracheal ; Laryngeal Masks* ; Lung ; Masks ; Oxygen ; Pharyngitis ; Positive-Pressure Respiration ; Pregnancy ; Sodium ; Tolnaftate ; Vecuronium Bromide ; Ventilation

Direct surgical repair of complex intracranial vascular lesions is difficult. Sometimes the neurosurgery is performed under circulatory arrest, profound hypothermia and barbiturates cerebral protection. Total ischemia is tolerated for 30~60 minutes because oxygen requirements of the brain decrease exponentially as body temperature is lowered. We experienced that this technique was successfully used for inoperable basilar artery aneurysm. We reviewed the surgical and anesthetic considerations of basilar artery aneurysm.
Aneurysm* ; Barbiturates ; Body Temperature ; Brain ; Hypothermia* ; Intracranial Aneurysm ; Ischemia ; Neurosurgery ; Oxygen

Nucleolar organizer regions(NORs) are intranucleolar segments of DNA coding for ribosomal RNA and contribute to the regulation of cellular protein synthesis. Since NOR-associated proteins are argyrophilic, silver staining method has been used for demonstration of NORs. The numbers of argyrophilic NORs(AgNORs) have been shown to be correlated with DNA ploidy and have prognostic value in diverse human neoplasms. However, the prognostic value of AgNORs in renal cell carcinoma(RCC) remain ill defined. We herein investigated the prognostic value of AgNORs in 39 patients with RCC. There was no significant relationship between mean number of AgNORs (m AgNORs) per nucleus and Robson stage and Fuhrman nunlear grade. However, there was significant relationship between the percentage of tumor cells with more than five AgNORs per nucleus (p AgNORs) and Robson stage and nuclear grade (p<0.05). There was significant difference in survival rate between patients with RCC in whom AgNORs were two or less and in whom AgNORs were greater than two(p<0.05). The patients with a low p AgNORs(less than 8%) have a better prognosis than those with a high p AgNORs. These results suggest that number of AgNORs may be a clinically useful prognostic marker for patients with RCC.
Carcinoma, Renal Cell* ; Clinical Coding ; DNA ; Humans ; Nucleolus Organizer Region* ; Ploidies ; Prognosis ; RNA, Ribosomal ; Silver Staining ; Survival Rate

BACKGROUND: Hepatic dysfunction may occur after single, or more usually repeated, exposures to the halogenated inhaled anesthetics. The cause may be free radical snd metabolites of inhaled anesthetics, immune reaction and hypoxic damage by decreasing total flows. The purpose of this study is to evaluate postoperative liver function between the general anesthesia and the thoracic epidural blockade supplemented with the light general anesthesia. METHODS: Thirty patients were divided into two groups; 15 patients were aneshtetized with 2 vo1% of enflurane combined with nitrous oxide(2 I/min) and oxygen(1.5 l/min) in the general anesthesia group, and in 15 patients of the thoracic epidural blockade group thoracic epidural blockade with 2% lidocaine and light general anesthesia using nitrous oxide(2 l/min) and oxygen(1.5 l/min) were performed. Serum glutamic oxalacetic transaminase(SGOT), serum glutamic pyruvic transaminase(SGPT) and alkaline phosphatase were evaluated before anesthesia, 1, 3, 5 and 7 days after gastric surgery on both groups. RESULTS: In the general anesthesia group, postoperative SGOT levels were increased above normal range but were within normal limits in the thoracic epidural blockade group. SGPT level was increased above normal range on postoperative one day in the general anesthesia group but no increase of postoperative SGPT levels was observed in the thoracic epidural blockade group. On postoperative seven days the level of alkaline phosphatase was increased within normal range in the general anesthesia but in the thoracic epidural blockade group the levels of alkaline phosphatase were not increased. CONCLUSIONS: We consider that postoperative liver function is not influenced with thoracic epidural blockade supplemented with light general anesthesia for upper abdominal surgery.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Aspartate Aminotransferases ; Enflurane* ; Humans ; Lidocaine ; Liver* ; Reference Values

A prospective study was conducted to evaluate the effect of length of scleral tunnel incision on postoperative intraocular pressure(IOP)after sutureless phacoemulsification and intraocular lens implantation in otherwise normal cataract patients. IOPs were measured preoperatively and postoperatively at 6 hour, 1 day, 3 days, 1 week, 2 weeks, 1 month, 3 months and 6 months respectively. A total 130 patients(141eyes) completed 6 months follow-up period and were divided into group 1 (3.5mm group, 74 eyes of 69 patients)and group 2(6.0mm group, 67 eyes of 61 patients) according to the length of scleral tunnel incision. A mean preoperative IOP was 14.0mmHg and increase of IOP was noted to 3.1mmHg compared to preoperative value but decreased after 1 day and maintained up to 6 month postoperatively. At 6 months mean IOP was 12.7mmHg and IOP decrease of 1.3mmHg was noticed compared to preoperative value. There were no statistically significant differences in mean IOP between groups during follow-up periods (p<0.05). Number of cases with IOP rise over 22mmHg was 11(14.8%) in group 1 and 11 (6.4%) in group 2 at 6 hour postoperatively but reduced to 3(2.1%). At 6 months no case showed IOP over 22mmHg. This study revealed that the length of scleral tunnel incision did not affect the degree and frequency of postoperative IOP rise fter sutureless cataract surgery.
Cataract* ; Follow-Up Studies ; Humans ; Intraocular Pressure* ; Lens Implantation, Intraocular ; Phacoemulsification ; Prospective Studies