Microsurgical free-tissue transfer has allowed surgeons to salvage injured limbs but choosing appropriate healthy recipient vessels has proved to be a difficult problem. Retrograde flow flaps are established in island flaps. Retrograde flow anastomosis could prevent the possible kinking and twisting of the arterial anastomosis. By not interrupting the proximal blood flow to the fracture or soft tissue defect site, the compromise of fracture or wound healing might be prevented. We wished to establish an animal model in rat for a retrograde arterial flow based free flap. Nembutal-anesthetized male rats, weighing 250 to 300 gm, were used. The femoral artery and common carotid artery exposed and divided. The systemic and retrograde arterial pressure were quantified by utilizing a paralle tubing system connected with peripheral arterial line. In this study, the retrograde flow was not pulsatile and the retrograde arterial pressure was 64-65 mmHg, with a mean arterial pressure of 106-109 mmHg. An epigastric skin flap, measuring 3x3 cm, was raised with its vascular pedicle. The epigastric free flap was transferred in the same rat from femoral vessels to carotid vessels in end to end fashion. We anastomosed the donor ateries to the distal parts of the divided recipient arteries and the donor veins to the proximal parts of the recipient veins. Twelve experiments were performed and the transplantations succeeded in 75 percent of them. In the remaining 25 percent, the experiments failed due to thrombosis at the site of anastomosis, or other causes. This animal model represents an excellent example of retrograde arterial flow free flap transfer that is reliable.
Animals ; Arterial Pressure ; Arteries ; Carotid Artery, Common ; Extremities ; Femoral Artery ; Free Tissue Flaps* ; Humans ; Male ; Models, Animal ; Rats ; Skin ; Surgical Flaps ; Thrombosis ; Tissue Donors ; Vascular Access Devices ; Veins ; Wound Healing

Tuberculosis of the bones and joints is not an uncommon condition in Korea, but extraosseous tuberculosis of the soft tissue is relatively rare. A few reports of extraosseous tuberculosis, tuberculous tenosynovitis and bursitis, hsve been published in the literature, but there have been no reports concerning soft tissue tuberculosis in other than the tendon, synovium and bursa. We reviewed 7 cases of soft tissue tuberculosis of the lower back at the Department of Orthopedic Surgery, Yonsei University College of Medicine from Jan. 1984 to Sept. 1986. Five cases had received steroid injection to the lumbosscral region, and two had undergone acupuncture, thus all seven cases had experienced injections to the lumbosacral region. We think that a possible route of infection is the hematogenous one, at an area of decreased local resistance after steroid injection, And that direct inoculation of the tuberculous bacilli was result of artificial injection and acupuncture. But, further studies are needed to support the proposal that the hematogenous route following steroid injection and direct inoculation by artifical puncture is the source of soft tissue tuberculosis. These results indicate that steroid injections into the soft tissue should be performed limitedly under sterile conditions.
Abscess ; Acupuncture ; Bursitis ; Joints ; Korea ; Lumbosacral Region ; Orthopedics ; Punctures ; Synovial Membrane ; Tendons ; Tenosynovitis ; Tuberculosis

Brain abscess is a rare, extremely aggressive, life-threatening infection. It may occur following : infection of contiguous structure, hematogenous spread, or cranial trauma/ surgery. Dental pathology and/or treatment have been linked to a small number of brain abscesses as possible source of infection. 50-year-old male patient was presented with a brain abscess caused by Streptococcus viridans. In the case presented, the significant oral findings were chronic periapical and periodontal infection due to root remnant of lower right 3rd molar. A case history and brief literature review of brain abscess related odontogenic infection was presented after successful treatment with antibiotics and craniotomy.
Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Craniotomy ; Humans ; Male ; Middle Aged ; Molar ; Pathology ; Viridans Streptococci

Brain abscess is a rare, extremely aggressive, life-threatening infection. It may occur following : infection of contiguous structure, hematogenous spread, or cranial trauma/ surgery. Dental pathology and/or treatment have been linked to a small number of brain abscesses as possible source of infection. 50-year-old male patient was presented with a brain abscess caused by Streptococcus viridans. In the case presented, the significant oral findings were chronic periapical and periodontal infection due to root remnant of lower right 3rd molar. A case history and brief literature review of brain abscess related odontogenic infection was presented after successful treatment with antibiotics and craniotomy.
Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Craniotomy ; Humans ; Male ; Middle Aged ; Molar ; Pathology ; Viridans Streptococci

Erythrodermic psoriasis (EP) is a very severe variant of psoriasis whose management poses a challenge to physicians, as currently available therapies often provide unsatisfactory results. Many biologics have been used to treat chronic plaque psoriasis, the most common form of psoriasis; however, their effectiveness for EP is poorly understood. A recently developed biologic, golimumab, has been extensively studied for the treatment of moderate-to-severe active rheumatoid arthritis, psoriatic arthritis, active ankylosing spondylitis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Here, we report the case of a 32-year-old man who presented with severe psoriasis that previously failed to respond satisfactorily to methotrexate, cyclosporine, retinoid, narrow-band ultraviolet B phototherapy, and topical agents (i.e., steroids and calcipotriol). Skin lesions worsened progressively and developed into erythroderma. Psoriatic arthritis was also detected. Conventional therapies lacked efficacy. Therefore, we administered golimumab 50 mg. The skin lesions improved significantly according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. Although additional studies are required to fully evaluate the efficacy and safety of golimumab, this agent may be an alternative treatment strategy for some patients with recalcitrant EP.
Adult ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Biological Products ; Cyclosporine ; Dermatitis, Exfoliative ; Humans ; Methotrexate ; Phototherapy ; Psoriasis* ; Skin ; Spondylitis, Ankylosing ; Steroids

Clear cell adenocarcinoma (CCAC) is a rare cancer that comprises less than 9% of the cervical adenocarcinoma cases. We experienced a case of fertility-sparing radical abdominal trachelectomy for cervical clear cell adenocarcinoma (CCAC). Thus, reported it. A 27 year old female was diagnosed with clinical stage Ib cervical CCAC. She had no history of maternal exposure to diethylstilbestrol and had negative PAP cytology and HPV tests. She was treated with neoadjuvant chemotherapy followed by radical abdominal trachelectomy. After 2 cycles of postoperative adjuvant chemotherapy, the lesion disappeared completely in an imaging study, and potential fertility was preserved. Radical abdominal trachelectomy with chemotherapy may be a valuable approach for treating stage Ib cervical CCAC in women that wish to preserve potential fertility.
Adenocarcinoma ; Adenocarcinoma, Clear Cell ; Chemotherapy, Adjuvant ; Diethylstilbestrol ; Female ; Fertility ; Humans ; Maternal Exposure ; Uterine Cervical Neoplasms

Transfusion free surgery is of increasing interest as more patients are refusing a blood transfusion because of religious belief, infection or fear of a blood-transmitted disease such as AIDS. Patients of the Jehovah's Witness faith generally do not accept transfusions of blood or blood products but some will accept cadaveric organs for transplantation. Recently, it is possible to perform 'bloodless' autologous or reduced-intensity allogeneic transplants in properly selected patients. The success of these procedures depends on the transplantation technique and on meticulous attention to blood conservation and supportive care. In our center, nine Jehovah's Witness received a kidney transplantations and transfusion free surgery. All the patients received erythropoietin injection and iron supplement before kidney transplantation. They were not serious bleeding in surgery and graft dysfunction after surgery. All the recipients are alive and have well functioning grafts. Elective living donor kidney transplantation allows implementation of a transfusion free strategy. We think that various methods replaced blood transfusion reduced risk of postoperative anemia and unnecessary transfusion.
Anemia ; Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Cadaver ; Erythropoietin ; Hemorrhage ; Humans ; Iron ; Kidney ; Kidney Transplantation ; Living Donors ; Religion ; Transplants ; Wit and Humor as Topic

Dextran of a low molecular weight (dextran 40) is frequently used to improve regional perfusion after surgery in spite of the potentially serious complications such as noncardiogenic pulmonary edema, oliguric renal failure, and coagulopathy that have been widely reported. Dextran is used to improve cochlear microcirculation in sudden deafness of vascular origin, but the frequency of complications is rarely reported in the field of otolaryngology. We reviewed the literature of a case we experienced in which a pregnant woman, after recovering from pulmonary edema caused by treatment for sudden deafness with dextran, had a successful vaginal delivery.
Dextrans* ; Female ; Hearing Loss, Sudden* ; Humans ; Microcirculation ; Molecular Weight ; Otolaryngology ; Perfusion ; Pregnant Women* ; Pulmonary Edema* ; Renal Insufficiency

Fetal bilateral renal agenesis is a lethal congenitlal anomaly. An early and prenatal diagnosis is extremely important, because it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, and the empty renal fossae. However, severe oligohydramnios makes it difficult to diagnose the disease because of poor sonographic resolution. We present a case of fetal bilateral renal agenesis diagnosed by ultrasonography at 21 weeks gestation.
Diagnosis ; Female ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Ultrasonography ; Ultrasonography, Prenatal* ; Urinary Bladder

BACKGROUND: There are limited literatures regarding the clinical characteristics of the specific dermatoses of pregnancy, and their terminology has been confusing and misleading. A simplified classification is proposed with the new terminology 'atopic eruption of pregnancy', comprising several disease entities such as eczema of pregnancy, prurigo of pregnancy, and pruritic folliculitis of pregnancy. OBJECTIVE: A clinical study was performed to determine the exact nature of atopic eruption of pregnancy in Korea. METHODS: We retrospectively reviewed the medical records of 75 patients who were diagnosed and reclassified as atopic eruption of pregnancy at Pusan National University Hospital. RESULTS: Among 121 patients with the specific dermatoses of pregnancy, 75 (62%) were diagnosed with atopic eruption of pregnancy. The most affected sites were the flexural surfaces of the neck and extremities, followed by the abdomen and back. The mean gestational age was 18.5 weeks. In 92% of cases, atopic eruption of pregnancy started during the 1st and 2nd trimesters of pregnancy. Major fetal problems were not seen. Atopic disease was observed in 26 (34.7%) patients. Total serum IgE levels were elevated in 10 (50%) patients among the 20 patients who were tested for IgE levels. Forty-four (58.5%) patients improved after delivery, and atopic eruption of pregnancy recurred after delivery in 6 (8%) patients. CONCLUSION: The characteristics of AEP in Korea were mostly similar to those of AEP in Western countries. However, AEP in Korea seems to show a poor prognosis and be refractory to treatment compared to that of Western countries.
Abdomen ; Busan ; Classification ; Eczema ; Extremities ; Folliculitis ; Gestational Age ; Humans ; Immunoglobulin E ; Korea ; Medical Records ; Neck ; Pregnancy* ; Prognosis ; Prurigo ; Retrospective Studies ; Skin Diseases