There are some effective methods for removing layers of skin to improve aging face and dermatologic defects : chemabrasion (chemical peeling), dermabrasion(surgical removal), laserabrasion. Chemabrasion, generally performed with a chemical solution, is most useful for removal of fine facial wrinkles and abnormal pigmentation. The application of chemical caustics, especially TCA (trichloroacetic acid), is known to be an effective and is now commonly practiced to improve the surface of the facial skin that has been blemished by pigmentation, wrinkles, solar damage and certain scars. Trichloroacetic acid is a colorless melting crystal and derivatives of acetic acid which das protein precipitating properties. It has specific odor but there is not systemic toxic effect like a phenol. It has heavy caustic effect on skin and mucosa and cause the coagulation necrosis of the skin and therefore, it must be handled carefully and stored in the proper condition. Especially, moderate to high concentrated TCA solution must be treated by well-trained persons. A 46-year-old woman visited a private clinic for removal of fine wrinkles around the lip. She was refered to our department because of acute upper lip coagulation necrosis which was caused by injection of 35% TCA solution mistaken for lidocaine, which was supposed to be used for anesthesia. At her arrival, cental half of upper lip showed severe coagulation necrosis. The lesion was well discriminated in a few days, then debridement and immediate reconstruction was done using an Abbe flap. Chemical peeling is a relatively effective procedure for improvement of aging skin lesion in a lower cost with a short time operation, if the practitioner has much experience and optimal indication is properly selected. But not so as, side effect and complication may be often ocurred in a mistake and as a result irreversible scars are remained. We experienced a rare case of upper lip necrosis which was caused by TCA injection mistaked for lidocaine in a private clinic and so, We report this case with the results of experiment of rabbit model which was observation of macroscopic and microscopic changes of the abdominal skin of the rabbit injected with serially diluted TCA solution.
Acetic Acid ; Aging ; Anesthesia ; Caustics ; Cicatrix ; Debridement ; Female ; Freezing ; Humans ; Lidocaine ; Lip* ; Middle Aged ; Mucous Membrane ; Necrosis* ; Odors ; Phenol ; Pigmentation ; Skin ; Trichloroacetic Acid

No abstract available.
Aneurysm*

No abstract available.
Gastrointestinal Neoplasms* ; Thymidine Kinase* ; Thymidine*

No abstract available.

The rib cartilage has been the most popular autogenous tissue for microtia reconstruction. Donor site complications, especially chest wall deformities occurring after harvest of costal cartilage graft are presented and discussed in many reports. In this study, 100 chest donor sites were evaluated in 34 patients (25 male and 9 female) who underwent costal cartilage grafts for microtia reconstruction from 1992 to 1999, and reviewed for donor site complications by radiography and physical examination. Ribs from which costal cartilage had been harvested showed increased inward bowing on radiographs in 38 of 100 donor sites; the upper ribs record a higher incidence of deformity than lower ribs. The frequency of rib deformity in donor site was 21 percent when cartilages were harvested from patients older than 10 years of age, whereas it was 73.3 percent in patients younger than 10 years. This difference was statistically significant. In our study, the incidence of chest wall deformity was 57 percent, concerning donor site morbidity after the supraperichondrial rib harvesting procedure, whereas it was 35 percent in patients after the subperichondrial rib harvesting procedure. In conclusion, surgeons should consider the possibility of thoracic deformity when planning costal cartilage grafting. To avoid these deformities, costal cartilage harvesting should be made at lower levels of the rib cage, and delayed operation time for thoracic maturation is recommended. More care should be taken to preserve the perichondrium and the germinative zone of the costochondrial junction.
Cartilage* ; Congenital Abnormalities ; Humans ; Incidence ; Male ; Physical Examination ; Radiography ; Ribs ; Thoracic Wall* ; Thorax* ; Tissue Donors ; Transplants

No abstract available.

OBJECTIVE: Direct revascularization surgery is regarded as the most effective method of treatment of adults with moyamoya disease. These patients, however, have a higher risk of perioperative ischemic complications than do patients with atherosclerotic stroke, and are at risk for ischemic complications in the hemisphere contralateral to the one operated on. We investigated the incidence and risk factors for ischemic stroke in the contralateral hemisphere after surgical treatment of adults with moyamoya disease. METHODS: We retrospectively reviewed the medical records and results of neuroimaging studies on 79 hemispheres of 73 consecutive patients with adult moyamoya disease (mean+/-SD age, 37.96+/-11.27 years; range, 18-62 years) who underwent direct bypass surgery over 6 years. RESULTS: Ischemic complications occurred in 4 of 79 (5.1%) contralateral hemispheres, one with Suzuki stage 3 and three with Suzuki stage 4. Three patients showed posterior cerebral artery (PCA) involvement by moyamoya vessels. Advanced stage of moyamoya disease (Suzuki stages 4/5/6; p=0.001), PCA involvement (p=0.001) and postoperative hypotension (mean arterial blood pressure <80% of preoperative mean arterial blood pressure) on the first (p<0.0001) and second (p=0.003) days after surgery were significantly correlated with postoperative contralateral ischemic complications. CONCLUSION: In patients with advanced moyamoya disease and involvement of the PCA, intentional hypotension can result in ischemic stroke in the hemisphere contralateral to the one operated on. Careful control of perioperative blood pressure is crucial for good surgical results.
Adult ; Arterial Pressure ; Blood Pressure ; Cerebral Revascularization ; Humans ; Hypotension ; Incidence ; Medical Records ; Moyamoya Disease ; Neuroimaging ; Passive Cutaneous Anaphylaxis ; Perioperative Period ; Posterior Cerebral Artery ; Retrospective Studies ; Risk Factors ; Stroke

Intraabdominal abscess usually causes distress with fever, leukocytosis, pain and toxicity. Diagnosis of intraabdominal abscess is occasionally difficult and it has high morbidity. However radiologic method, such as ultrasonography, CT scan, or RI scan are helpful to early detection of intraabdominal abscess. Among these methods, ultrasonography is a noninvasive technique and performed without discomfort to patient. And also differential diagnosis between cystic and solid lesion is very easy and sequential ultrasonography in same patient is valuable for the evaluation of treatment effect. We analyzed the ultrasonic features of 48 cases with intraabdominal abscesses and the results are as follows; 1. In total 48 cases, the intraabdominal abscesses were 30 cases, the retroperitoneal abscesses, 5 cases, and the visceral abscesses, 13 cases. 2. The causes of the intraabdominal abscesses were perforating appendicitis (25 cases), postoperative complications (5 cases), pyogenic and amebic hepatic abscesses (13 cases), and the other (5 cases). 3. Round or oval shaped lesions were 26 cases (54%), irregular shape, 18 cases (38%), and multiple abscess formation in 4 cases (8%). 4. The size of the lesions were between 5 and 10cm in diameter in 54% of total 48 cases, and the most frequent feature of the echo pattern of the lesions was cystic with or without internal echogenicity (69%).
Abdominal Abscess* ; Abscess ; Appendicitis ; Diagnosis ; Diagnosis, Differential ; Fever ; Humans ; Leukocytosis ; Liver Abscess ; Methods ; Postoperative Complications ; Tomography, X-Ray Computed ; Ultrasonics ; Ultrasonography

No abstract available.
Stevens-Johnson Syndrome*

BACKGROUNDS: Moyamoya disease is a progressive occlusive cerebrovascular disease which has characteristics of distal ICA stenosis and basal collateral vessels. Various methods of surgical treatment are recommended in the literatures but surgical strategies and outcome are not well established yet. AIMS AND METHODS: The aims of study is to evaluate surgical outcomes of moyamoya disease and to establish surgical indications. Total 155 patients diagnosed with moyamoya disease since 1990, were analyzed retrospectively. Female was more predominant by 1.5 : 1. There were two peaks of age of onset at the 1st decade (39.0%) and 4th (15.9%). Familial occurrence was 6.8% (n=17). The mean duration of follow-up was 41.1 months (12-156 months). Moyamoya syndrome was excluded in this study. Surgical outcomes were measured by grading activity of daily living (ADL) and prognostic factors were analyzed statistically with SAS. RESULT: The most common clinical presentations were transient ischemic attacks (69.1%), followed by cerebral infarction (26.0%) and hemorrhage (4.9%) in pediatric patients, but in adult hemorrhage (49.2%) was the most prevalent. Recurrence of symptoms developed in 8 patients (11.4%) among 70 of cerebral infarction with mean intervals of 30.8 months and 7 patients (21.9%) among 32 of hemorrhage with mean interval of 42.3 months. Forty five (29.0%) of 155 patients showed stenosis of posterior cerebral arteries on cerebral angiography at the age of diagnosis. The surgical treatment were performed at 183 hemispheres of 115 patients, direct bypass surgery was done in 10 hemispheres, indirect bypass surgery in 169 hemispheres (106 EDAMS, 14 EDAS, 40 frontal EDS or burr hole, 6 EDAMS and EDAS, 3 others), combined direct and indirect bypass surgery in 4 hemispheres. The improvement of ADL was not so different between 68 (59.1%) of 115 patients treated with surgery and 23 (57.5%) in 40 patients with conservative care. The initial and final grade of ADL of pediatric patients were better than those of adult (p<0.01). The grades of ADL of patients with transient ischemic attack were better than those with infarction or hemorrhage (p<0.01). Those patients with recurrent hemorrhage were poorer in the outcome than recurrent infarction (p<0.05). The incidence of recurrent infarction in the surgical cares was lower than that in conservative care (5.9% vs 26.3%, p<0.05), but there was no statistical difference between two groups with regard to rebleeding (8.3% vs 30.0%, p>0.1). Significant prognostic factors affecting outcomes of moyamoya disease age at onset, clinical features, and initial grade of ADL. CONCLUSION: Children with transient ischemic attack were the best, but adults with recurrent hemorrhage were the worst in outcomes. Surgical treatment for moyamoya disease should be carefully tailored according to age of onset and clinical features regardless of surgical methods. Further prospective study is indicated to determine optimal treatment guideline for moyamoya disease.
Activities of Daily Living ; Adult ; Age of Onset ; Cerebral Angiography ; Cerebral Infarction ; Child ; Constriction, Pathologic ; Diagnosis ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Infarction ; Ischemic Attack, Transient ; Moyamoya Disease* ; Posterior Cerebral Artery ; Recurrence ; Retrospective Studies