The recent development of microsurgical tissue transfer has enabled any defect in any area to be reconstructed with free flaps. However, the need for a more functional and thinner flap has been raised due to bullkiness of the flap and donorsite morbidity. For better functional and aesthetic results, various perforator flaps excluding muscles or adjacent subcutaneous tissue have been recently reported. We report 44 cases of perforating artery pedicled flaps from April 1995 to August 1998, including 21 cases of anterolateral thigh flap, 12 cases of gluteal artery perforator flap, 4 cases of posterior interosseous flap, and 7 cases of paraumbilical perforator flap for various soft tissue defects. Even though marginal necrosis of flap occurred in 9 cases, complete healing without significant problem was possible. The advantages of perforator flaps are as follows: 1. It is possible to obtain a relatively thin fasciocutaneous flap, but still with sufficient volume 2. Donor site morbidity was reduced without damage of main artery. 3. In spite of diverse vascular pattern of the perforator, the location of perforating arteries can be Detected with relative ease and mapped preoperatively with an ultrasound Doppler. The need of meticulous and tedious dissection could be a sole disadvantage of these flaps. This report describes the clinical experience with a perforator-based flap, anticpating applications of many other types of perforator flap in the future.
Arteries* ; Free Tissue Flaps ; Humans ; Muscles ; Necrosis ; Perforator Flap ; Subcutaneous Tissue ; Surgical Flaps* ; Thigh ; Tissue Donors ; Ultrasonography

Zygomatic arch fracture is one of the most commonly seen facial bone fractures and there have been many methods of reduction designed so far. However, for a simple fracture, the Gillies temporal approach is most commonly used because of the easy reducibility, and also because the depressed fracture can be approached without a facial incision. The Gillies temporal approach starts in the temporal area, between the temporalis muscle and deep temporal fascia. We have developed a new route which starts in the postauricular hair margin area and then reaches to the periosteum of the temporal bone. An elevator is then inserted to penetrate the periosteum and subperiosteal dissection is performed toward the zygomatic process of the temporal bone. At the origin of the zygomatic process, the route of dissection changes to the posterior aspect of the zygomatic arch using a curved palate elevator or the authors' modified Langenbeck elevator. This method of approach has been used in 6 cases of zygomatic arch fracture with good results and we report this method along with written reports.
Elevators and Escalators ; Facial Bones ; Fascia ; Hair ; Palate ; Periosteum ; Temporal Bone ; Zygoma*

No abstract available.
Multiple Organ Failure* ; Sepsis*

A retrospective study was made in 21 patients who angiographically diagnosed as moyamoya or moyamoya-like disease over the last 10 years. Computed tomography of the patients showed semorrhage, infarction or normal. Carotid angiography revealed various stages unilaterally or bilaterally. Seventy-five percent of the venous phase on the side of arterial occlusion demonstranted some abnormalities. Two children with unilateral abnormality showed arterial occlusion at supraclinoid portion of internal carotid arteries. On the other hand 5 adults with unilateral abnormality showed occlusion at variable sites of internal carotid artery.
Adult ; Angiography ; Carotid Artery, Internal ; Child ; Hand ; Humans ; Infarction ; Moyamoya Disease* ; Retrospective Studies

To date no consensus has been reached regarding the suitability of surgical treatment for spontaneous intracerebral hemorrhage, especially in deep seated cases. With the recent introduction of an alternative to conservative therapy, craniotomy or stereotactic aspiration, it has become even more difficult to determine which therapeutic approaches should be used. We used stereotactic aspiration technique under a local anesthesia instead of craniotomy to treat 48 patients, because we believe that better therapeutic results could be obtained by minimal invasion to the brain. In present study, we analysed the level of consciousness and clinical outcome, location and volume of hematoma, interval of operation from ictus, and rate of hematoma removal. Our series consist of 18 males and 30 females. The most prevalent age group of intracerebral hemorrhage patients were the 6th decades. The hematoma were located at basal ganglia in 75%, thalamus in 15%, pons in 8%, and lobar 2%. The prognosis was favorable in patients with good neurological grade at admission, but was unfavorable in those with large volume although the statistical difference was not significant. Rate of hematoma removal was high in the cases where operations performed after 4 days. The statistical difference between the time interval from hemorrhage to operation and prognosis was not significant. The overall mortality rate was 17%. These results seem to indicate that stereotactic aspiration may play a comparable indices in the treatment of spontaneous intracerebral hemorrhage.
Anesthesia, Local ; Basal Ganglia ; Brain ; Cerebral Hemorrhage* ; Consciousness ; Consensus ; Craniotomy ; Female ; Hematoma ; Hemorrhage ; Humans ; Male ; Mortality ; Pons ; Prognosis ; Thalamus

To observe the role of oxygen free radical and enzymatic scavengers in cerebral ischemia, an infarction model was made using transorbital occlusion of the middle cerebral artery in cats. The changes of the superoxide radical production and the activities of superoxide dismutase and catalase were measured. The results were as follows ; 1) The infarction of the left middle cerebral artery(MCA) territory was identified with intracardiac perfusion of a TTC solution after transorbital occlusion. 2) The superoxide radical activities after occlusion of the left MCA were not changed in all groups except for the decrease in 6 hours group of the right side compared to the control group(p<0.05). 3) The Mn-superoxide dismutase activities of the left side in the 12 hours group were significantly higher than those of the right side(p<0.01) and those in the control group(p<0.05). 4) The Cu, Zn-superoxide dismutase activities of the left side in the 3 hours group after occlusion of the left MCA were significantly higher than those in the control group(p<0.05). 5) The catalase activities of the left side in the 3 hours, 6 hours and 12 hours groups after occlusion of the left MCA were significantly higher than those of the right side(p<0.05). 6) The catalase activities of the left side in the 12 hours group after occlusion of the left MCA were significantly higher than those in the control group(p<0.05). The authors suggest that the enzymatic scavangers such as Mn-SOD, Cu, Zn-SOD and catalase increased in the infarcted brain, which means an involvement of free radicals in cerebral infarction.
Animals ; Brain ; Brain Ischemia ; Catalase* ; Cats ; Cerebral Infarction* ; Free Radicals ; Infarction ; Middle Cerebral Artery ; Oxygen ; Perfusion ; Superoxide Dismutase* ; Superoxides*

A retrospective study 40 patients with moderate or severe diffuse axonal injury which is defined as posttraumatic coma for over 24 hours without mass lesions or ischemic insults was conducted in order to identify prognostic parameters. The sign of hypothalamic damage and motor reactivities of 40 patients were reviewed and compared to the outcome. The results were as follows ; 1) The ratio of male to female was about 3 to 1 and the peak incidence was at the first decade. 2) Of abnormal brain stem signs, fever of central origin was observed at the early posttraumatic phase and correlated with nonrecovery of consciousness(P<0.05). 3) Of abnormal brain stem signs, abnormal ADH secretion was significantly correlated with nonrecovery of consciousness(P<0.005). 4) Abnormal motor reactivity to pain was significantly correlated with nonrecovery of consciousness(P<0.005). 5) In the group of recovery of consciousness, initial Glasgow coma scale in 40 patients with moderate or severe DAI was significantly correlated with their outcome(P<0.005).
Brain Stem ; Coma ; Consciousness ; Diffuse Axonal Injury* ; Female ; Fever ; Glasgow Coma Scale ; Humans ; Incidence ; Male ; Retrospective Studies

Trigeminal neuralgia is a cranial rhizopathy characterized by paroxysms of hyperactivity strictly limited to the anatomical distributions of the fifth cranial nerve. One of a documented cause is vascular cross-compression at the root entry zone of the fifth cranial nerve near the brain stem. The offending vessels are the superior cerebellar artery, anterior inferior cerebellar artery, small arteriole, vein only, and vertebrobasilar artery in order of frequency. When trigeminal neuralgia and hemifacial spasm occur together in the same patient in rare occasions, they are termed "tic convulsif" We have recently experienced three cases of trigeminal neurlgia caused by unusual offending vessels and one case of tic convulsif. They were treated by microvascular decompression using Teflon felt. Post-operative courses were uneventful and marked symptomatic improvement had been achieved.
Arteries ; Arterioles ; Brain Stem ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery ; Polytetrafluoroethylene ; Tics* ; Trigeminal Nerve ; Trigeminal Neuralgia* ; Veins

Pleomorphic xanthoastrocytoma is a recently characterized neoplasm with relatively favorable prognosis despite aggressive histological features. Two cases of pleomorphic xanthoastrocytoma involving the left temporal lobe are reported, both occurring in adolescents. The tumor is considered to arise from the subpial astrocytes of the superficial cortex. Electron microscopic examination and immunoperoxidase stains for glial fibrillary acidic protein(GFAP) are helpful in making a definitive histologic diagnosis. In contrast to malignant gliomas, pleomorphic xanthoastrocytoma does not appear to require aggressive postoperative radiation therapy or chemotherapy. Therefore, It is important to recognize and identify this type of glioma as a distinct entity.
Adolescent ; Astrocytes ; Coloring Agents ; Diagnosis ; Drug Therapy ; Glioma ; Humans ; Prognosis ; Temporal Lobe

The upper thoracic vertebrae through anterior approach depends upon several variables; The diameter of the thoracic inlet, the height of the clavicles and manubrium anteriorly, and the extent of the cervicothoracic kyphosis. Preoperatively, the upper margin of the manubrium should be compaired with the vertebral body level on a standard lateral roentegenogam or mid-sagittal MRI of the upper thoracic spine. We measured the distance and the level of the corresponding vertebra of line A(horizontal line from the suprasternal notch to the corresponding vertebra) and line B(perpendicular line from the suprasternal notch to the corresponding vertebra ; thoracic inlet) on mid-sagittal MRI of normal subjects. The results were as follows: 1) In 95 cases(94 cumulative %), the line A fell to the T2 lower one third through T4 lower one third and the mean distance was 49.8+/-4.2mm(means standard deviation). 2) In 92 cases(91 cumulative %), the line B fell to the T1 lower one third to T3 middle one third and the mean distance was 45.5+/-4.9mm(means standard deviation). 3) The relation of the height and the distance with age, sex, weight, height, and body mass index were not statistically significant. We concluded that anatomical analysis of the mid-sagittal MRI of the cervicothoracic vertebrae will be helpful in selecting the access route to the cervicothoracic lesion.
Adult* ; Bays ; Body Mass Index ; Clavicle ; Humans ; Kyphosis ; Magnetic Resonance Imaging ; Manubrium ; Spine* ; Thoracic Vertebrae