No abstract available.
Fetal Development* ; Pregnancy*

Background: The advance in microsurgical technique has facilitated a proper approach for reconstruction of extensive head and neck defects. For the success of free tissue reconstruction, selection of the recipient vessel is one of the most important factors. However, the vascular anatomy of this region is very complex, and a clear guideline about this subject is still lacking. In this study, we present our 30 years of experiences of free tissue reconstruction for head and neck defects. Methods: In this retrospective study, we analyzed a total of 138 flaps in 127 patients who underwent head and neck reconstruction using free tissue transfer following tumor resection between October 1986 to August 2019. Patients who underwent facial palsy reconstruction were excluded. Medical records including patient’s demographics, detailed operation notes, follow-up records, and photographs were collected and analyzed. Results: Among a total of 127 patients, 10 patients underwent a secondary operation due to cancer recurrence. The most commonly used type of flap was radial forearm flap (n= 107), followed by the anterolateral thigh flap (n= 18) and fibula flap (n= 10). With regard to recipient vessels, superior thyroid artery was most commonly used in arterial anastomosis (58.7%), and internal jugular vein (51.3%) was the first choice for venous anastomosis. The flap survival rate was 100%. Four cases of venous thrombosis were resolved with thrombectomy and re-anastomosis. Conclusion Superior thyroid artery and internal jugular vein were reliable choices as recipient vessels. Proper recipient vessel selection could improve the result of head and neck reconstruction.

No abstract available.
Angiotensin II* ; Angiotensins* ; Animals ; Hemorrhage* ; Rats*

PURPOSE: Irritations or painful stimuli to the bladde: may alter voiding behaviorand this may be associated with dysfunction of periurethral muscles. In our study, recording of bladder and sphincter activity in response to intravesical irritants(acetic acid, capsaicin) was done and the effects of Intrathecal administration of transmitters(enkephalin, susbtance P and its antagonist, or calcitonin gene related peptide and its antagonist) was analyzed MATERIALS AND METHODS: Adult male Sprague-Dawley rats(400-500gm) were anesthetized with intraperitoneal urethane mixed with entobar. The left femoral artery and vein were cannulated for blood pressure monitoring and drug administration. A catheter(PE 50) was inserted into the bladder dome through a midline abdominal incision and bipolar electromyographic(EMG) needle electrodes were placed into the urethral sphincter. Peak contractile pressure and EMG activities were measured on a polygraph. Saline, acetic acid, or capsaicin was infused into the bladder at 50mu1/min and saline, enkephalin (ENK), substance P(SP) and its antagonist, or calcitonin gene related peptide (CGRP) and its antagonist was administered intrathecally. RESULTS: Each micturition cycle started with an increase in bladder pressure which triggered the contraction of the external urethral sphincter. Fast Fourier transform(FFT) analysis of the external sphincter EMG revealed a peak activity at 500Hz. The inteNal and duration of EIOG bursts were 38+/-2 msec and 92+/-10 msec respectively. The interval of bladder contraction was 809+/-23 sec. Intravesical acetic acid and capsaicin activated micturition reflex earlier than in control group and intrathecal ENK, SP antagonist, and CGRP antagonist attenuated the parameters in activated micturition reflex. CONCLUSIONS: Urethral sphincte EMG showed constant burst duration and interval in spite of the infusion of acetic acid or capsaicin. Intravesical acetic acid or capsaicin increased the peak amplitude of intravesical pressure, lowered voided volume, and shortened EMG spike duration and voiding interval significantly. Intrathecal injection of ENK, SP, SP antagonist, CGRP, and CGRP antagonist changed the parameters, especially the voiding interval, voiding duration and peak pressure of the bladder.
Acetic Acid ; Adult ; Blood Pressure Monitors ; Calcitonin Gene-Related Peptide ; Capsaicin ; Electrodes ; Enkephalins ; Femoral Artery ; Humans ; Injections, Spinal ; Male ; Muscles ; Needles ; Rats, Sprague-Dawley ; Reflex* ; Urethane ; Urethra ; Urinary Bladder ; Urination* ; Veins

Menetrier's disease is a rare, characterized by the presence of large rugal folds involving part or all of the stomach. Patients with hypertrophic gastropathy often have distressing abdominal symptoms, weight loss, and edema due to gastric protem loss. A 64 year old male patient was admitted with the chief complaint of epigastric discomfort. Endoscopic, radiologic and histologic examination, revealed characteristic findings of Menetrier's disease. A case of Menetrier's disease is reported with a brief review of literature.
Edema ; Gastritis, Hypertrophic* ; Humans ; Male ; Middle Aged ; Stomach ; Weight Loss

PURPOSE: To determine the hemodynamics of the pancreas by investigating the enhancement patterns of pancreaticparenchyma, as seen on spiral CT, after the administration of various amounts of contrast medium, and to determineoptimal scan time by knowing the peak time of normal pancreatic parenchyma. MATERIALS AND METHODS: Between January1995 and April 1997 55 cases of normal abdominal CT with dynamic enhancement study on pancreas, the subject were38 cases(28 persons) with good image, aged 21-65 years, men were twenty-one and women were seven. Non-ioniccontrast medium, 30ml(n=15), 60ml(n=9), 990ml(n=7), and 120ml(n=7) were injected at a rate of 3ml/sec. From 20sec. after the start of injection, 15 images were obtained at 3-sec intervals. Before and after injection, R.O.I.was applied to each image, and for the aorta and pancreatic parenchyma, Hounsfield units(H.U.) were measured; timeof enhancement and maximal H.U. were also measured. RESULTS: After 30, 60, 90, and 120ml of contrast mediuminjection, mean maximal H.U. of pancreatic parenchyma was 36+/-7, 54+/-6, 68V13, and 92+/-8, respectively; mean valueat peak parenchymal enhancement of the pancreas was 27+/-3, 32+/-3, 42+/-3, and 52+/-3, respectively. Time intervalsof maximal enhancement of aorta and pancreatic parenchyma could not be obtained in 30ml injection, but 5,4+/-2.5,4.2+/-1.6, and 6.0+/-2.1sec in 60, 90, and 120ml injection, respectively. CONCLUSION: Maximal H.U. of parenchymalenhancement of the pancreas is directly proportional to the amount of injected contrast medium and the peak timeof parenchymal enhancement was 12sec after the injection of contrast material. Time interval of maximalenhancement of aorta and pancreatic parenchyma was 5.2+/-2.1sec.
Aorta ; Contrast Media ; Female ; Hemodynamics ; Humans ; Male ; Pancreas* ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed

Twenty patient's capsular lesions were detected by high resolution brain computed tomograhpy (CT). Eighteen of them had systemic hypertension. Two patients had prior stroke episodes that were of the same nature. All of the patients had sudden onset of neurologic deficits. Their neurologic syndromes were pure motor stoke (10 cases), ataxic hemiparesis (3 cases), pure motor stroke with dysphasia (1 cases), pure sensory-motor stroke (3 cases), pure motor stroke with tremor, locked-in syndrome, and hemiparesis with latered consciousness, each 1 case respectively. The CT showed capsular infarcts of ovolid or round hypodense lesion that was smaller than 20mm in diameter and that was seen on only two scan sections. The sites of capsular infarcts were genu(5 cases), posterior limb (9 cases), genu-posterior limb (3 cases), genu-anterior limb (3 cases), and anterior limb (4 cases) respectively. Large capsulo-putamino-caudate infarcts, or giants lacunes (type 1 of Rascol et al ) are seen in 3 cases only in pure motor stroke ; Posterior limb capsular Iacunes (type 2 of Rascol et al), 6 cases in pure motor stroke, 3 cases in ataxic hemiparesis, 2 cases in pure sensory-motor stroke, 1 case in modified pure motor stroke with tremor : Anterior capsular lacunes (type 3 of Rascol et al), 1 case in pure motor stroke, 1 case in modified pure motor stroke with dysphasia, 1 case in modified pure motor stroke with memory and cognitive dysfunction. None of the capsular infarct caused mass effect. In five cases there was a relatively complete neurologic improvement, in 14 cases did the patients show mild residual neurologic deficit, and one patient expired. With the use of CT, the diagnosis of capsular infarcts has moderately increased.
Aphasia ; Brain ; Consciousness ; Diagnosis ; Extremities ; Humans ; Hypertension ; Memory ; Neurologic Manifestations ; Paresis ; Quadriplegia ; Stroke ; Tremor

Drug-induced acute interstitial nephritis is characterized by renal interstitial inflammatory cell infiltration and commonly presents as acute renal failure. This is caused mainly by methicillin, non-steroidal antiinflammatory drugs, sulfonamide diuretics such as thiazide, but cases induced by furosemide are rare. We report a patient with acute interstitial nephritis causing reversible acute renal failure and dermatitis while she was taking furosemide. A 37-year old woman was referred to our hospital because of generalized skin rash and non-oliguric acute renal failure. She had peripheral eosinophilia (1,577/mm3) and serum creatinine level of 6.8mg/dL. Skin biopsy showed leukoclastic vasculitis and percutaneous renal biopsy showed severe interstitial infiltration of lymph ocyte and mild interstitial fibrosis with focal tubular atrophy. After withdrawal of furosemide, renal function and skin lesions were completely recovered.
Acute Kidney Injury ; Adult ; Atrophy ; Biopsy ; Creatinine ; Dermatitis ; Diuretics ; Eosinophilia ; Exanthema ; Female ; Fibrosis ; Furosemide* ; Humans ; Methicillin ; Nephritis, Interstitial* ; Skin ; Vasculitis

Neuroendocrine neoplasm of the larynx is a morphologically heterogeneous group of tumors. This unusual neoplasm includes the four different type of tumors. Paraganglioma is the best-known neural origin tumor. The epithelial origin tumor is further divided based on the degree of differentiation into well, moderately, and poorly differentiated carcinoma. The diverse biological behavior of neuroendocrine neoplasm of larynx makes an accurate diagnosis of paramount importance, since treatment depends on diagnostic accuracy. The diagnosis is based primarily on light microscopy, and immunohistochemical and/or ultrastructural investigations are needed to diagnose correctly. The mainstay of treatment of moderately differentiated neuroendocrine carcinoma of the larynx is surgery. Elective neck treatment should be performed considering the high likelihood of cervical lymph node metastases. The 5-yr survival rate approximates 50%, and 10-yr survival rate is only 30%.
Carcinoma, Neuroendocrine ; Larynx ; Light ; Lymph Nodes ; Microscopy ; Neck ; Neoplasm Metastasis ; Paraganglioma ; Survival Rate

Central hyperthermia is a very rare disease; however, once it happens, it is associated with a poor prognosis and high mortality for patients with severe brainstem strokes. Following a pontine hemorrhage, a 46-years-old female developed prolonged hyperthermia. Work-ups to the fever gave no significant clues for the origin of fever, and hyperthermia did not respond to any empirical antibiotics or antipyretic agents. The patient's body temperature still fluctuated in a range of 37.5degrees C to 39.2degrees C. Considering the lesion of hemorrhage, we suspected central hyperthermia rather than infectious diseases. We started with baclofen administration at a dose of 30 mg/day. The body temperature changed to a range of 36.6degrees C to 38.2degrees C. We raised the dose of baclofen to 60 mg/day. The patient's body temperature finally dropped to a normal range. Central hyperthermia, caused by failures of thermoregulatory pathways in brainstem, following the pontine hemorrhage rarely occurs. Baclofen can be used to treat suspected central hyperthermia in a patient with pontine hemorrhage.
Anti-Bacterial Agents ; Antipyretics ; Baclofen* ; Body Temperature ; Brain Stem ; Communicable Diseases ; Female ; Fever* ; Hemorrhage* ; Humans ; Mortality ; Pons ; Prognosis ; Rare Diseases ; Reference Values ; Stroke