PURPOSE: There are several methods for the reconstruction of partial urethral defect. Split-thickness skin graft, full-thickness skin graft, prepuce flap and free flap are those. Despite partial success using these methods, most results are unsatisfactory due to frequent complications such as postoperative infection, fistula formation, hair growth and stricture. There has been several pioneering experiments in this field using autogenous vein graft, but the results of this procedures were controversial. Therefore, this study was designed to illustrate the possibility of using vein graft for the reconstruction of partial urethral defect. MATERIALS AND METHODS: Two different types of vein graft method were performed in total 20 New Zealand White rabbits with partial urethral defect. Firstly, for the patch graft group, 1x cm rectangular vein graft was sutured at defective area of the same size. Secondly, for the tubed graft group, vein graft segment of 1 cm long was replaced at segmental urethral defect of the same length. Histologic study was performed at 3 and 8 weeks postoperatively in each group. And retrograde urethrogram was checked at eight weeks postoperatively. RESULTS: On histologic study, the process of transitional cell epithelial replacement within grafted vein was uniformly observed in both experimental group at three week postoperatively. At eight weeks postoperatively, the epithelial replacement was almost complete and histologically undistinguishable. In the retrograde urethrogram performed on the day of the 8th week postoperatively, in patch graft group, contrast material was well advanced to the bladder and showed no stricture, and two of five rabbits of tubed graft group showed mild stricture with luminal patency at the graft site. CONCLUSIONS: Natural urethral epithelium was restored in grafted venous segment irrespective of type of graft. Mild stricture was observed in 40% of tubed graft group while complete reconstruction was possible in patch graft group.
Constriction, Pathologic ; Epithelium ; Fistula ; Free Tissue Flaps ; Hair ; Phenobarbital ; Rabbits* ; Skin ; Transplants* ; Urethra ; Urinary Bladder ; Veins*

PURPOSE: To determine the usefulness of cerebral perfusion computed tomography (CT) in patients with acute cerebral ischemic infarction. MATERIALS AND METHODS: Twelve patients with acute middle cerebral artery infarction underwent conventional CT and cerebral perfusion CT within 25 hours of the onset of symptoms. For each patient, perfusion CT scans were obtained at the levels of the basal ganglia and 1 cm caudal to them. Using special imaging software, perfusion imaging maps for cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time to peak (TTP) were created, and the infarcted lesion was evaluated on each map. MTT and TTP delay times were measured in the perfusion defect lesion and symmetric contralateral normal cerebral hemisphere. Lesion size on each perfusion map was determined and compared with the value obtained by diffusionweighted MR imaging (DWMRI). RESULTS: In all patients, perfusion CT maps depicted the perfusion defect lesion, for which the MTT and TTP delay was remarkable. A comparison of lesion size between each perfusion map and DWMR images showed that the closest correlation involved CBF maps (8/12, 67%). On MTT maps, the lesion was larger than at DWMRI, suggesting that MTT mapping can be used to evaluate ischemic penumbra. CONCLUSION: Perfusion mapping facilitates the evaluation not only of the ischemic core and ischemic penumbra, but also of hemodynamic status in the area of the perfusion defect. This finding demonstrates that perfusion CT can be useful for the diagnosis and treatment of patients with acute cerebral ischemic infarction.
Basal Ganglia ; Blood Volume ; Cerebrum ; Diagnosis ; Hemodynamics ; Humans ; Infarction* ; Infarction, Middle Cerebral Artery ; Magnetic Resonance Imaging ; Perfusion Imaging ; Perfusion* ; Tomography, X-Ray Computed

Surgery for the inflammatory abdominal aortic aneurysm (IAAA) is a technically challenging procedure and it's associated with increased morbidity and mortality. Injuries of the vena cava, the duodenum, the left ureter and the renal vein are common in an operation for IAAA. Herein, we report 2 cases of ligation of the left renal vein during repair of the IAAA. Cases: The 1st case was a 75- year-old male patient, who had an abrupt onset of abdominal pain and a pulsatile abdominal mass. An 8.5 cm sized IAAA and left hydronephrosis were detected via CT angiogram. During the operation, the left renal vein was mobilized and then divided to gain access to the aneuysmal neck. We couldn't reconstruct the divided left renal vein. On the follow-up CT scan, the left renal vein drained into the left paravertebral plexus, and no renal congestion was demonstrated. The 2nd patient was a 72-year-old male who experienced sudden abdominal pain and a growing pulsatile mass on the abdomen. A huge IAAA 10.5 cm in diameter was detected in CT scan. During the repair of IAAA, the left renal vein was divided and ligated to expose the neck of the aneurysm. The divided left renal vein was anastomosed to the splenic vein in an end-to-side fashion instead of performing direct reconstruction. On follow-up CT scan, neither left renal congestion nor significant increment of the portal venous flow was noted. The two patients were doing well at the 15th and 10th postoperative month, respectively.
Abdomen ; Abdominal Pain ; Aged ; Aneurysm ; Aortic Aneurysm, Abdominal* ; Duodenum ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Humans ; Hydronephrosis ; Ligation* ; Male ; Mortality ; Neck ; Renal Veins* ; Splenic Vein ; Tomography, X-Ray Computed ; Ureter

A 59-year-old man visited an emergency room due to the sudden onset of severe dysarthria with a drowsy mental status. MRI demonstrated T2 prolongation and restricted diffusion involving the splenium of the corpus callosum and bilateral frontal white matter neurological signs and symptoms were mild, and the recovery was complete within a week. Follow-up MRI performed one month later revealed complete resolution of the lesions. The clinical and radiological courses were consistent with previously reported reversible isolated splenial lesions in mild encephalitis/encephalopathy except for the presence of frontal lesions. This case suggests that such reversible lesions can occur outside the splenium.
Corpus Callosum* ; Diffusion ; Dysarthria ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Middle Aged

Irisin is a myokine caused by exercise that improves insulin resistance and weight loss. However, under unfavorable conditions such as air pollution, and during the pandemic, outdoor activities are uncomfortable. Therefore, in this study, the effect of heat therapy (half bath 42 ± 0.5°C for 30 min) on irisin circulation levels as an exercise alternative for middle-aged obese women after menopause was investigated. Subjects were 33 women aged 49.54 ± 6.04 years, with parameters of height, 160.12 ± 4.33 cm, weight, 69.71 ± 7.52 kg, body surface area 1.73 ± 0.13 m2 , body mass index, 27.19 ± 3.40 kg/m2 . The results suggest that circulating irisin levels showed a significant increase after one-time thermotherapy (TH-1). However, the increase in circulating irisin levels after 15 treatments (TH-15, 5 days/week, 3 weeks) was significantly varied. The level of adiponectin, which increases fatty oxidation to reduce fatty deposition, increased significantly at TH-1, but further increased at TH-15, which was significantly different from the level of TH-1. In addition, the basic serum free fatty acid (FFA) level was significantly increased at TH-15 compared to TH-1. Significant differences were also found in the lipid profile (body mass index, waist circumference, and % body fat). Thermotherapy can significantly increase the tympanic temperature and induce changes in circulating irisin and adiponectin levels. Thus, it resulted in positive changes in FFA and lipid profiles. Therefore, repeated thermotherapy is effective in increasing circulating irisin levels in postmenopausal obese women.

PURPOSE: Bezoars are the uncommon result of ingestion of poorly digestible or indigestible substances. It is defined as retained concretions of animal or vegetable material in the gastrointestinal tract. The aim of this study was to review and analyze in these cases with reviewing literature. METHODS: The medical records of 12 cases, treated between May 1999 and April 2009, were reviewed. The clinical characteristics, as well as the diagnostic evaluations and results of medical and surgical treatment, were also analyzed retrospectively. RESULTS: Of the 12 cases, 6 men and 6 women, the bezoars were in the stomach, jejunum and ileum or in both stomach and jejunum in 1, 2, 7 and 2 cases, respectively. 4 patients (33.3%) had a history of gastric or duodenal ulcer following previously received gastric surgery such as subtotal gastrectomy or truncal vagotomy with pyloroplasty. In 3 cases, the bezoars were found in operative field under the impression of intestinal obstruction due to adhesive ileus, which could not be found by preoperative radiologic evaluation. Among the 12 cases, 11 cases were successfully treated by operative and endoscopic removal, but 1 case expired due to sepsis. CONCLUSION: A bezoar occurs mainly in patients who have previously undergone a gastric operation. Surgeons should keep in mind the possibility of bezoars in patients presenting an intestinal obstruction following a past gastric operation. The principle of treatment for bezoars used to be surgery, but recently gastric bezoars are often treated by gastrofiberscopy.
Abdomen, Acute ; Adhesives ; Animals ; Bezoars ; Duodenal Ulcer ; Eating ; Female ; Gastrectomy ; Gastrointestinal Tract ; Humans ; Ileum ; Ileus ; Intestinal Obstruction ; Jejunum ; Male ; Medical Records ; Retrospective Studies ; Sepsis ; Stomach ; Vagotomy, Truncal ; Vegetables

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system characterized by optic neuritis and longitudinal extensive transverse myelitis. The clinical course can be either polyphasic (relapsing-remitting) or monophasic. The relapsing-remitting course is observed in more than 80% of NMO cases, and relapse generally occurs within 1 year in 60% of patients, and within 3 years in 90%. We report a rare case of long spontaneous remission in untreated NMO.
Central Nervous System ; Demyelinating Diseases ; Humans ; Myelitis, Transverse ; Neuromyelitis Optica ; Optic Neuritis ; Recurrence ; Remission, Spontaneous

Retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention. That may occur due to trauma to the ostium from catheter manipulation and may sometimes require surgical repair. A 50-year old male patient was admitted because of chest pain. During catheterization of the right coronary artery (RCA) after ergonovine test, we encountered coronary artery dissection with retrograde dissection of right sinus of Valsalva leading to RCA occlusion. Then we placed coronary artery stent (4.0x24 mm Driver stent) at right coronary artery ostium and his coronary blood flow of RCA was recovered and no further extension of dissection was observed. Here, we present a case of acute myocardial infarction which resulted from the acute dissection of the sinus of Valsalva with obstruction of the right coronary ostia by intimal flap during angiography.
Angiography ; Catheterization ; Catheters ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Ergonovine ; Humans ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Sinus of Valsalva ; Stents

PURPOSE: Arteriovenous fistulas (AVF) are crucial for hemodialysis in patients with end stage renal disease. However, the lack of suitable forearm cephalic veins has led the surgeons to perform alternative procedures, such as transposition of basilic vein or prosthetic A-V graft. To increase the use of the autologous vein in AVF, we tried a technique of basilic venous transposition of the forearm. METHOD: From 2005.1.1 to 2006.6.30, Six patients had AVFs created with a transposed basilic vein of the forearm. We estimated postoperative clinical outcomes such as primary patency rate and operative complications. RESULT: Three of six patients were male and the mean age was 66.2 yr. Two patients were having their first AVF operation, and the others were having their second AVF operation. The mean follow-up period was 14.8 months. Early graft failure was occurred in one (16.7%). The 1-year primary and secondary patency rates were 66.7%, 83.3%, respectively. CONCLUSION: Autologous AVF formation with basilic vein transposition of the forearm was a feasible surgical technique by increasing the chances autologous AVF formation, this procedure could save the vessels on the upper arm for later AVF creation, and so it avoids using artificial grafts. However, this technique needs further study of more detailed clinical outcomes in large series including the long term patency rate, surgical complications, and comparative results to other AVF formation techniques.
Arm ; Arteriovenous Fistula* ; Follow-Up Studies ; Forearm* ; Humans ; Kidney Failure, Chronic ; Male ; Ocimum basilicum* ; Renal Dialysis ; Transplants ; Veins*