Numerous surgical procedures have been advocated to correct the facial deformity in patients with hemifacial microsomia, including chondrocostal grafts, mandibular osteotomies combined with bone grafts, and maxillary osteotomies done at an early age after permanent dentition is completed. The standard treatment of these malformations consists of the application of bone grafts which can lead to unpredictable growth. Furthermore, these procedures often require intermaxillary fixation, blood transfusions and sometimes tracheostomies. Lengthening of the mandible by gradual distraction, according to the method of Ilizarov, opens new perspectives for interceptive therapy. Laboratory and clinical studies have shown that mandibular distraction is an effective and powerful reconstructive surgical technique. Lengthening of the mandible by gradual distraction was performed on five patients of hemifacial microsomia and one patient of Goldenhar syndrome using unidirectional or bidirectional extraoral device and intraoral device. In two patinets, simultaneous mandibular and maxillary distraction was performed with incomplete Le Fort I osteotomy. The amount of mandibular bone lengthening ranged from 8 to 21 mm, the patinets were maintained in fixation for an average of 12 weeks to allow ossification. There was no severe perioperative complication and the length of clinical follow-up ranged from 3 to 17 months. The skeletal change resulting from directional bone lengthening could be seen best by comparing the pre-and postoperative 3-D CT scans. There was also the potential for improvement in neuromuscular function (functional matrix), attendant growth and development of the affected jaw. Mandibular distraction is a simple procedure with minimal morbity and complications, so the results to date indicated that the technique can be applied to the correction of hemifacial microsomia. The development of new devices should permit multidirectional mandibular distraction and craniofacial distraction to allow early reconstruction of cranio-maxillofacial malformations. Distraction osteogenesis for reconstruction of the mandible in this subest of young patients was a safe and effective technique for improving the craniofacial skeletal form and appearance, with minimal associated morbidity.
Blood Transfusion ; Bone Lengthening ; Congenital Abnormalities ; Dentition, Permanent ; Follow-Up Studies ; Goldenhar Syndrome* ; Growth and Development ; Humans ; Jaw ; Mandible ; Mandibular Osteotomy ; Maxillary Osteotomy ; Osteogenesis, Distraction ; Osteotomy ; Tomography, X-Ray Computed ; Tracheostomy ; Transplants

A case of metastatic alveolar soft part sarcoma is presented with clincal, pathological and radiological features. Alveolar soft part sarcoma is a rare soft-tissue neoplasm that is malignant and invariably fatal. It was first described and named by Christopherson, et al. in 1952. Since 1952 numerous examples of this tumor have been reported and have been studied with the electron microscope, but there is still considerable uncertainty as to the exact histogenesis of the tumor. Most cases occur in young females involving the lower extrimities especially in the right side. The most initial presenting symptom is a slowgrowing painless mass and the principal metastatic sites are the lungs, followed by the brain and skeleton. Cerebral metastasis, in fact, may be the first manifestation of the disease. Treatment is radical surgical excision but radiotherapy and chemotherapy are less effective. We present the reported case of metastatic alveolar soft pat sarcoma with electron microscopic findings.
Brain ; Drug Therapy ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Radiotherapy ; Sarcoma ; Sarcoma, Alveolar Soft Part* ; Skeleton ; Uncertainty

Angiosarcomas are rare tumors that are derived from vascular endothelial cells. They may occur in various sites, including the skin, breast, visceral organs and deep soft tissues. The pleura usually a metastatic site from angiosarcomas. However, thirty one cases of primary pleural angiosarcomas have been reported worldwide. Here, we report a 61-year-old man with a primary angiosarcoma of the pleura with a brief review of the literature.
Breast ; Endothelial Cells ; Hemangiosarcoma* ; Humans ; Middle Aged ; Pleura* ; Skin

PURPOSE:We report the results of image-guided percutaneous biopsies with a biopsy gun and evaluate the clinical usefullness. MATERIALS AND METHODS: One hundred and five biopsies under ultrasonographic or fiuoroscopic guidance were performed. Various anatomic sites were targeted (liver;50, chest;22, kidney;12, pancreas;8, intraperitoneum;7, retroperitoneum; ). RESULTS:Obtained tissue was diagnostic in 98 of the 105 biopsies(93%). In each instance, representative core tissue specimens were obtained. Evaluation of the core tissue by pathologist revealed consistent, uniform specimens that contained significant crush artifact in no case. Five biopsies yielded inadeguate tissues which were too small for histopathologic interpretation or were composed of necrotic debris. Two biopsies yielded adequate tissues, but tissues were not of the target. The diagnoses were malignancy in 77 biopsies and benign disease in 21 biopsies. No complications other than mild, localized discomfort were encountered except a transient hemoptysis and pneumothorax which was observed in two patients. CONCLUSION:Cutting biopsy with a biopsy gun provided sufficient amount of target tissue for an accurate diagnosis of malignant and benign disease. It was a safe and useful procedure for percutaneous biopsy.
Artifacts ; Biopsy* ; Diagnosis ; Hemoptysis ; Humans ; Pneumothorax

No abstract available.
Athletes* ; Forearm* ; Humans ; Magnetic Resonance Spectroscopy* ; Metabolism* ; Phosphorus*

BACKGROUND: Experimental data indicate that low-flow reperfusion following prolonged cardiocirculatory arrest may aggravate early cerebral microcirculatory repefusion disorders. We investigated the influence of cerebral repefusion flow change to the ischemic histopathologic damage of brain tissue after incomplete forebrain ischemia in rats. MATERIALS AND METHOD: Anesthetized Sprague-Dawley rats were undergone ligation of both infernal carotid artery by microvascular clamp for 10 minutes. After release of the clamp, reperfusion was started with several different flow levels (0, 10, 20, 30, 50, and 100%) of infernal carotid artery comparing to pre-clamping phase using flowmeter. After 15minutes of reperfusion, rat brains were prepared by perfusion-fixation with 3% formaldehyde. Under light microscopic examination of Hematoxylin-Eosin stained tissue slide, histopathologic damage was examined at cortex, putamen, and hippocampus regions. Categorical hisotopathologic damage scores were derived in each regions by manual counts of ischemic neurons. RESULT: The histopathologic damage scores were 0, 10. 2+/-0.5, 7.6+/-1.5, 5.9+/-1.4, 5.0+/- 2.8, 3.5+/-0.7, and 1.0+/-0.0 in control, 0, 10, 20, 30, 50, and 100% reperfusion groups, respectively(p<0.05). CONCLUSION: Our insults showed significant increment of brain histopathologic damage scores along with decreasing amount of cerebral reperfusion know after incomplete forebrain ischemia. We believe restoration of repefusion flow to pre-ischemic level would be a critical component in attenuation of brain ischemic damage.
Animals ; Brain ; Carotid Arteries ; Flowmeters ; Formaldehyde ; Hippocampus ; Ischemia* ; Ligation ; Models, Animal* ; Neurons ; Prosencephalon* ; Putamen ; Rats* ; Rats, Sprague-Dawley ; Reperfusion*

This study was desinged for compare the efficacy of ephedrine infusion that of crystalloid administration in reducing the incidence of hypotension during spinal anesthesia. Sixty ASA 1 and 2 patients scheduled for transurethral prostatic resection and lower extremity surgery under spinal anesthesia were ramdomly allocated to receive either 15 ml/kg crystalloid (crystalloid group) or an ephedrine infusion (infusion group). Spinal anesthesia was performed using 12-14 mg of 0.4% tetracaine. Analgesic sensory level was T10 in both groups, Thirty patients in the crystalloid group received crystalloid solution (Ringer'lactate solution, 15 ml/kg) within 20 min prior to induction of spinal anesthesia. Thirty patients in the infusion group immediately after induction spinal anesthesia received ephedrine infusion at a rate 5 mg/ min for the first 2 min and then 1 mg/min for the next 18 min. Cardiovascular responses (systolic blood pressure and heart rate) and complications (hypotension, nausea and vomiting) after induction of spinal anesthesia were compared and results were as follows; 1) The incidence of hypotension was ll/30 (36%) in the crystalloid group and 3/30 (10%) in the infusion group (p<0.001). 2) Systolic blood pressure after induction of spinal anesthesia in the crystalloid group significantly decreased from 5 min to 20 min as compared to the infusion group (p<0.05). But, systolic blood pressure did not decrease siginificantly until 9 min after spinal anesthesia in the infusion group. 3) The mean heart rate after induction of spinal anesthesia in the crystalloid group significantly increased at 1 min as compared to infusion group; thereafter, there was no significant difference between the two groups. 4) The incidence of nausea and vomiting was 1/30 in the crystalloid group and 0/30 in the infusion group; The difference between the two groups was not significant. 5) Reactive hypertension or tachycardia did not occur in either group. Considering above results, we conclude that a prophylactic ephedrine infusion is effective for minimizing and managing hypotension associated with spinal anesthesia.
Anesthesia, Spinal* ; Blood Pressure ; Ephedrine* ; Heart ; Heart Rate ; Humans ; Hypertension ; Hypotension* ; Incidence ; Lower Extremity ; Nausea ; Tachycardia ; Tetracaine ; Vomiting

PURPOSE: To evaluate the usefulness of dynamic CT during the hepatic arterial phase with rapid IV injection ofcontrast material in distinguishing hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICAC) asthe cause of biliary obstruction. MATERIALS AND METHODS: We retrospectively reviewed two-phase dynamic incrementalCT or helical CT findings in 22 patients with intrahepatic duct obstruction secondary to pathologically provenHCCs (n=12) or ICACs (n=10). Two-phase CT scans were obtained 20-45 seconds (hepatic arterial phase) or 2 minutes(equilibrium phase) after the initiation of a bolus injection of contrast material (5 mL/sec, 150 mL). Theenhancement patterns of tumors, as seen on two-phase images, were classified as hypo-, iso-, or hyperattenuated,relative to surrounding liver parenchyma. Two-phase images were compared and correlated with pathologic findings. RESULTS: During the hepatic arterial phase, diffuse high-enhancement was seen in nine HCCs (75%) and partialenhancement in three (25%); five (50%) of the ten ICACs were hypodense and five (50%) were hypodense withperipheral enhancement. During the equilibrium phase, however, all HCCs were hypodense and capsular enhancementwas seen in four cases (33.3%). All ICACs were hypodense with mild peripheral or central heterogeneousenhancement. Contrast enhancement patterns of HCCs during the hepatic arterial phase were significantly different(P<.0001) from those of ICACs. CONCLUSION: Our results suggest that dynamic CT during the hepatic arterial phase,with rapid IV injection of contrast material, is useful for the differentiation of HCC from ICAC as the cause ofbiliary obstruction.
Carcinoma, Hepatocellular* ; Cholangiocarcinoma* ; Humans ; Liver ; Retrospective Studies ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

The purpose of this study was to investigate the effects of smoking on adult periodontitis after non-surgical periodontal therapy. The study population consisted of 40 patients with moderate to advanced periodontitis. Smokers(n=20) were defined as individuals smoking at least twenty cigarettes per day at the time of the initial examination. The non-smoking group(n=20) second and the fourth weeks after periodontal non-surgical therapy. The results were as follows; 1. Clinical indices including plaque index, gingival index, and pocket depth were decreased in both smoking and non-smoking group at the first, the second, and the fourth weeks. Especially, clinical indices of non-smokers were more significantly decreased than those of smokers. 2. Non-motile rods were increaseed and motile rods were reduced at the fourth week. spirochetes were reduced significantly in the non-smoking group at the fourth week. These results suggest that smoking play a minor role in adult periodontitis after non-surgical periodontal therapy.
Adult* ; Chronic Periodontitis* ; Humans ; Periodontal Index ; Periodontitis ; Smoke* ; Smoking* ; Spirochaetales ; Tobacco Products

No abstract available.
Cystic Adenomatoid Malformation of Lung, Congenital* ; Lung*