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

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*

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

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

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

The clinical course of individual patient with renal cell carcinoma (RCC) is variable and difficult to predict accurately. The values of various classical prognostic factors in RCC remain ill-defined. Data on molecular analysis of oncogene and tumor suppressor genes including p53 may provide useful prognostic information for RCC. We herein investigated the prognostic value of multiple clinical and pathological parameters as well as p53 mutation in 40 patients with pathologically confirmed RCC. Mutations of p53 gene were analyzed by immunohistochemical staining using monoclonal antibody for p53 protein( M1801). On univariate analysis using log-rank test multiple parameters showed prognostic value, including clinical stage ( Robson), nuclear grade, mutation of p53, cell type, body weight loss, anemia, and increased serum level of calcium and erythrocyte sedimentation rate. However, on multivariate analysis using Cox's proportional hazard model only three parameters including stage(p <0.001 ), nuclear grade(p < 0.05), and mutation of p53(p<0.05) were found to have significant independent prognostic value. These results suggest that in RCC clinical stage and nuclear grade are two most important prognostic factors and analysis of p53 mutation may provide additional important prognostic information.
Anemia ; Blood Sedimentation ; Calcium ; Carcinoma, Renal Cell* ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Multivariate Analysis ; Oncogenes ; Proportional Hazards Models ; Somatotypes ; Weight Loss

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

We report bilaterally fractured Hydroflex implants in 2 patients. One fracture was complete and three were incomplete. All the fractures occurred at the junction of the rear reservoir and the inflation chamber.
Adult ; Case Report ; Equipment Design ; Human ; Male ; *Penile Prosthesis ; Prosthesis Failure

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

Laryngeal mask airway(LMA) is a new type of airway, which may be used as an alternative to either the endotracheal tube or the face-mask with either spontaneous or positive pressure ventilation without penetration of the larynx or esophagus. LMA have many advantages of easy intubation without laryngoscope and muscle relaxants, decreasing damages of larynx and pharynx., and also useful in difficult intubation or emergency airway care. Recently its interesting has been increased. Clinical studies of LMA was done in 242 patients, about hemodynamic changes, volume and pressure changes of cuff, problems and complications during insertion and maintaining of LMA. The results were as follows: 1) The average time taken to insert the laryngeal mask airway was 9.9sec(range:5~60sec), and 43 cases were correct placement at the second attempt. And the total insertion time was 103 min(range:15~355min). 2) Total ari volume of cuff was 20.5ml(range:15~35ml) in LMA No 3, 28.1 ml(range:25~60ml) in LMA No 4. The least volume of cuff without air leakage was 15ml in LMa No 3 and 25ml in LMA No 4. During positive pressure ventilation the peak airway pressure was 20 cmH2O(15mmHg). 3) In hemodynamic changes, blood pressure was increased about 27.5 mmHg in systolic, 21.2 mmHg in diastolic, and 22.4 mmHg in mean arterial pressure after LMA insertion. 4) Cuff pressure was increased from 70.5mmHg at insertion to 98.9mmHg after 1hours with use of N2O for anesthesia and more increased than without N2O. 5) LMA was used 229 patients in supine position and 5 patients in lateral position. In 8 cases was failed to insertion of LMA. 6) Compilcations were 3 cases of gastric distention, 1 case of difficult nasogastirc tube insertion, and 1 case of severe sore throat with mucosal bleeding on pharyax. Sor throat was complained 26.9% without regard to severity.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Emergencies ; Esophagus ; Hemodynamics ; Hemorrhage ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopes ; Larynx ; Pharyngitis ; Pharynx ; Positive-Pressure Respiration ; Supine Position