In the case of a soft tissue defect which requires thin & pliable tissues, the choice of donor site is limited due to flap bulkiness and donor site morbidity. To overcome these problems, a variety of perforator-based flaps such as paraspinous and parasacral perforator flap, deep inferior epigastric perforator flap, gluteal perforator flap, and thoracodorsal artery perforator flap have recently been introduced. We experienced 8 cases of soft tissue defects from December 1996 to March 1999 using the thoracodorsal artery perforator flap for reconstruction. We could elevate the cutaneous flap with preservation of the latissimus dorsi muscle flap only when it was based on one cutaneous perforator. Defatting procedure was possible for further thinning of skin flap. In one case, axillary defect after release of postburn scar contracture was repaired with island perforator flap and the other seven cases were repaired with free flap. The results were satisfactory. We believe the thoracodorsal artery perforator flap is useful for reconstruction of soft tissue defects which are large or under conditions requiring thin flap.
Arteries* ; Cicatrix ; Contracture ; Free Tissue Flaps ; Humans ; Perforator Flap ; Skin* ; Superficial Back Muscles ; Tissue Donors

No abstract available.
Adolescent* ; Humans

No abstract available.
Salivary Glands*

Fetal hydrops is often serious and associated with a high perinatal motality rate. Cardiac causes of fetal hydrops include congenital heart diseases and rhythm disturbances. An irregular fetal heart rate may indicate atrial fibrillation and atrial flutter with variable AV conduction. Fetal atrial flutter is characterized by the pressence of flutter waves which are regular sawtooth undulations in the baseline that are larger than p waves. Authors experienced a case of fetal atrial flutter with hydrops fetalis at 30 week's gestation which was confirmed by fetal M-mode echocardiogram and electrocardiography. A new born infant had shown to have atrial flutter in utero and after delivery was successfully converted to normal sinus rhythm with digoxin and quinidene.
Atrial Fibrillation ; Atrial Flutter* ; Digoxin ; Edema* ; Electrocardiography ; Female ; Heart Diseases ; Heart Rate, Fetal ; Humans ; Hydrops Fetalis* ; Infant ; Pregnancy

A 61-year-old man was admitted to the emergency room complaining of a severe left exophthalmos caused by frontal and ethmoid sinus mucoceles that were visualized on a brain computerized tomogram. In addition, he had coexisting ankylosing spondylitis with a 20 year duration that resulted in total fixation of the cervical spine and progressive thoracic kyphosis. An unruptured anterior communicating artery aneurysm was found incidentally on the cerebral angiogram. We report that the anesthetic management for endoscopic sinus surgery of a frontal sinus mucocele in a patient with coexisting severe cervical spine ankylosing spondylitis and an unruptured cerebral aneurysm requires a detailed preoperative assessment of the airway, cardiac, pulmonary, and neurologic system. This case highlights the need for careful measures to avoid rupturing the cerebral aneurysm by the increased blood pressure induced by endotracheal intubation and the infiltration of an epinephrine-containing local anesthetic.
Blood Pressure ; Brain ; Emergencies ; Ethmoid Sinus ; Exophthalmos ; Frontal Sinus ; Humans ; Intracranial Aneurysm ; Intubation, Intratracheal ; Kyphosis ; Middle Aged ; Mucocele ; Spine ; Spondylitis, Ankylosing

BACKGROUND: Alzheimer's disease (AD) and vascular dementia (VaD) are the most frequently occurring dementia. Although accurate differentiation of dementia subtype is important in treatment perspective, it is not easy even using expensive and time-consuming devices. To evaluate diagnostic value of the Modified Mini-Mental State (3MS) examination as a dementia screening and whether the first recall (FR) and delayed recall(DR) of 3MS are helpful in differentiating AD from VaD. METHODS: Patients comprised of 64 cases diagnosed for dementia at the Neurology department. Diagnosis of probable AD (n=34) and VaD (n=30) were made according to consensus criteria. Cognitive status was measured by the Mini-Mental State Examination (MMSE) and 3MS. Receiver operating characteristic (ROC) curves were used to identify the optimal FR and DR for differentiating AD from VaD. Ninety-three age- and education-matched controls were evaluated. The neuropsychologist was blind to clinical diagnosis. RESULTS: Sensitivity (SN), specificity (SP), diagnostic accuracy (DA), and positive likelihood ratio (+LR) of 3MS (cutoff score=76) were 0.75, 0.68, 0.70 and 2.34. The optimal score of FR and DR to differentiate AD from VaD were 2 (SN=0.81, SP=0.76, and +LR=3.38) and 1 (SN=0.81, SP=0.71, and +LR=2.79), respectively. CONCLUSIONS: The diagnostic value of 3MS is comparable to that of MMSE as well as covers broader cognitive functions and has wider difficulty levels. Among dementia patients, a low FR and DR scores on the 3MS produce small to moderate increases the post-test probability of AD.
Alzheimer Disease* ; Consensus ; Dementia ; Dementia, Vascular* ; Diagnosis ; Humans ; Mass Screening ; Neurology ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: The Folstein Mini-Mental State Examination (MMSE) is a well-established and reliable cognitive screening instrument. However, recent investigations have reported limitations in the MMSE as a cognitive screening tool. The Modified Mini-Mental State Examination (3MS) taps a broader range of cognitive abilities by including evaluations of semantic fluency, delayed memory, remote personal information, and abstraction as well as those areas included in the MMSE. We report age- and education-specific reference values of the Korean Modified Mini-Mental State (K-3MS) Examination and the MMSE in the non-demented elderly population. We also evaluate the validity and reliability of the K-3MS for cognitive screening. METHODS: The K-3MS and the MMSE were administered to 112 dementia patients and 99 controls, aged 50~90 years old. K-WAIS, K-DRS, CDR were done with K-3MS in dementia patients. Test-retest reliability coefficients were obtained from 50 patients. NINCDS-ADRDA criteria for probable AD and NINDS-AIREN criteria for VaD were used. RESULTS: The K-3MS correlated with the MMSE (r=0.94, p<0.05). The area under the receiver operating characteristic (ROC) curve for the K-3MS was 0.872 and for the MMSE was 0.865. There was no statistically significant difference between both tests. The sensitivity and specificity of the K-3MS (cutoff score=72) for a dementia diagnosis were 0.83, 0.78 and those of the MMSE (cut-off score=23) were 0.78, 0.74. The K-3MS was found to have high test-retest reliability (r=0.93). CONCLUSIONS: The K-3MS is a reliable, valid, and stable cognitive screening instrument. The K-3MS is comparable to the MMSE as a dementia screening test.
Aged ; Dementia ; Diagnosis ; Humans ; Mass Screening ; Reference Values ; Repression, Psychology ; Reproducibility of Results* ; ROC Curve ; Semantics ; Sensitivity and Specificity

BACKGROUND: Since a change in venous capacitance significantly alters venous return and thus affects cardiac output, it is important to know the effects of vasodilators on venous capacitance. The purpose of this study was to examine the effects of sodium nitroprusside and nitroglycerin on venous capacitance during induced hypotension in halothane anesthetized dogs. METHODS: Fourteen mongrel dogs(SNP group: 7, NTG group: 7), weighing 10~15 kg, were anesthetized with N2O 1.5L/min-O2 1.5L/min-halothane 0.5vol%. Each dog received only one drug. In dogs anesthetized with N2O-O2-halothane, mean arterial pressure(MAP) was decreased by 15%(mild hypotension) and 30%(deep hypotension) of control value by sodium nitroprusside(SNP) and nitroglycerin (NTG), respectively. Venous capacitance was assessed before and during induced hypotension by measuring mean circulatory filling pressure(MCFP). MCFP was measured after arresting the circulation by tightening of superior vena cava and inferior vena cava snares simultaneously. RESULTS: As compared with MCFP before induced hypotension, MCFP was significantly decreased by SNP at deep hypotension and NTG at mild hypotension and deep hypotension. As compared with MCFP at mild hypotension, MCFP at deep hypotension was significantly decreased by NTG and SNP, respectively. CONCLUSIONS: These results suggest that NTG has potent venodilating effect at mild and deep induced hypotension, whereas SNP has venodilating effect only at deep induced hypotension.
Animals ; Cardiac Output ; Dogs* ; Halothane* ; Hypotension* ; Nitroglycerin* ; Nitroprusside* ; Pharmacology ; SNARE Proteins ; Sodium* ; Vasodilator Agents ; Vena Cava, Inferior ; Vena Cava, Superior

Purpose: The purpose of this study was to understand and describe the meaning of the experience of male nurses working in Intensive Care Units (ICU). Methods: Data were collected through in-depth interviews with 8 male nurses. Data were collected from november 2019 to february 2020 and were analyzed using Colaizzi's method, a phenomenological approach. Results: 8 theme clusters, and 28 themes were identified. The 8 clusters were as follows; the feeling of burden in a busy and sensitive situation, the daily life facing life and death, female colleagues and patients who are still difficult to treat, a reliable and grateful male colleague, being proud of this role that a man can do, various experiences that improve me, constant effort to be recognized as a team member, and wavering and weighing in the career. Conclusion These results could help to expand understanding the role of male nurses working in the ICU and in other areas. In addition, the results provide basic data needed to improve mutual respect and relationships between male and female nurses. It is necessary to offer mentoring programs for male nurses to adapt to nursing field.

An intrathoracic mass that manifested compression sign of large vessel and heart by mass was confirmed as huge sinoatrial nodal artery aneurysm and resection of aneurysm was performed. Preoperative precise diagnosis of coronary artery aneurysm is difficult because the most coronary artery aneurysm is incidentally confirmed during diagnostic coronary angiography or autopsy. So huge coronary artery aneurysm which manifests compression sign of large vessel and heart by the mass may be misdiagnosed as simple mediastinal mass. We reports huge coronary artery aneurysm that manifested compression sign of large vessel and heart by the mass with reviews of anesthetic management and diagnostic approach.
Aneurysm* ; Arteries* ; Autopsy ; Coronary Angiography ; Coronary Vessels ; Diagnosis ; Heart* ; Humans ; Thoracic Surgery*