Reconstruction of partial ear defect to approximate the opposite normal ear is actually very difficult. Because the patterns of partial ear defect (site, shape and size of defect) are extremely variable, the operative method on each case should be changed. In an effort to overcome these problems, many reconstructive methods have been reported so far. We experienced 11 cases of partial ear defect from September, 1995 to August, 1996 and different reconstructive methods were applied In this study, the most common cause of partial ear defect was trauma (9 cases) and the most common site was middle part of ear helix. The defects were varying from 1x2 cm to 1.5x5 cm in size. The methods that has been used for reconstruction of ear defect include direct closure, helical chondrocutaneous advancement flap, Dieffenbach's method, retroauricular flap, tubed bipedicled flap and so on. We could get to know the merits and demerits of each method through this follow up study. So authors obtained the several basic conclusions about the merits and demerits of each method and standard of method selection in various patterns of ear defects. From analysis of the cases with review of literature, the our conclusions are as follows. 1. If the size of de(tract is small and the patient does not want to have two times of operation, direct closure can be done with good results. 2. If the defect exists on ear auricle confuted to helix and if there are no or small amount of associated cartilage defect, tubued bipedicled flap seems to be proper. 3. With the ear auricle defect confined to helix, especially helix of upper ear auricle, helical chondrocutaneous advancement flap can brought tile best result, though it has disadvantage of being decreased in its size 4. If there are extensive defect on ear auricle extending over scapha and antihelix, retroauricular flap can be done with good results. 5. In the ear auricle defect acompanying considerably large cartilage loss, Dieffenbach's method is thought to be proper.
Cartilage ; Ear Auricle ; Ear* ; Follow-Up Studies ; Humans

No abstract available.
Resuscitation* ; Shock, Hemorrhagic*

Hurthle cell tumors are an infrequent neoplasm of the thyroid gland in adults. Hurthle cell tumors represent 4. 5% to 10% of all primary thyroid epithelial neoplasms in the foreign literature. It has been known as Hurthle cell tumor since Ewing was the first to use this term in 1928. Tumor occurring in an infant was described by Symmers(1941) and Morrow(1945). The authors experienced a case of congenital Hurthle cell tumor of the thyroid gland in a 2 months old boy. He was admitted to the pediatric surgical department because of a growing mass in the neck since birth. Ultrasonogram showed a huge lobulated homogenous solid mass with medium level echogenicity in the region of the thyroid gland. Subtotal thyroidectomy of right lobe and total thyroidectomy of left lobe were done. The specimen measures 2x3x1.5 cm and 7x3x3 cm, respectively. It was an encapsulated, yellow gray firm and solid mass. The cut surface was smooth, glistening and homogenous. Microscopicully, the tumor was composed of tightly packed regular follicles lined by polyhedral, cuboidal, large cells with a granular acidophilic cytoplasms. The nuclei are vesicular, usually only a little bit larger than those of normal thyroid cells.
Infant ; Adult ; Male ; Female ; Humans

No abstract available.
Cerebral Hemorrhage* ; Mucormycosis*

OBJECTIVE: The study was performed to evaluate whether thallium reinjection (RI) distinguishes viable from nonviable myocardium among myocardial segments which showed persistent perfusion defect (PD) in patients with acute myocardial infarction (AMI). MATERIALS AND METHODS: We studied 22 patients underwent PTCA after AMI. SPECT was performed in all patients using dipyridamole stress- 4 hour redistribution (RD) followed by 24 hour RI protocols. Dysfunctional segs were classified into 5 groups: 1) normal, 2) reversible, 3) mild to moderate PD, 4) severe PD and 5) reverse redistribution (RR). All patients underwent follow up echocardiography after 4 months to assess regional wall motion (WM) improvement such as a criteria of viable myocardium. RESULTS: A total of 127 segs with abnormal WM was analyzed. Of 74 segs with PD, 17 (23%) showed enhanced uptake after 24 hour RI. Five of 17 segs (29%) with PD that responded to RI with enhanced thallium uptake showed WM improvement. WM improvement were seen in the 24 of 57 segs (42%) not responding to RI. All four segs (100%) with RR that responded to RI showed improvement. WM improvement were not seen in the 5 of 8 segs (71%) with RR not responding to thallium RI. Eleven (73%) of 15 segs with mild-moderate PD after RI showed improvement, but 33% of segs with severe PD after RI did not showed improvement. Segs with mild-moderate PD after RI and fill in after RI showed improvement in comparison to segs with severe PD after RI(p<0.05). CONCLUSIONS: These data indicate that because only small proportion of PD showed further perfusion improvement after RI and predictive value by the uptake after RI was low, there was limited role of RI after myocardial infarction. Usefulness of RI could be found in segs showing RR responding to RI in AMI reflects viable myocardium.
Dipyridamole ; Echocardiography ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Myocardium ; Perfusion ; Thallium ; Tomography, Emission-Computed, Single-Photon

No abstract available.
Occupations*

Background: Esmolol is rapid hydrolyzed by plasma esterase but may inhibit plasma cholinesterase activity based on its structure. This study was designed to evaluate the interactions between esmolol and succinylcholine or mivacurium which are metabolized by plasma cholinesterase and to determine the inhibitory effect of esmolol on human plasma cholinesterase. Methods: Neuromuscular effects of succinylcholine (1.0 mg/kg) and mivacurium (0.15 mg/kg) with or without esmolol (0.5 mg/kg or 1.0 mg/kg) were compared in 57 adult patients (ASA class I) during O2-N2O-isoflurane anesthesia. Neuromuscular block was monitored by recording the compound electromyogram of the hypothenar muscle resulting from supramaximal train of four stimuli applied to the ulnar nerve. Also plasma cholinesterase activity was measured before and 5, 10 minutes after injection of esmolol. Results: Time from injection to onset of over 95% block, clinical duration from injection to 25% recovery of control twitch, and recovery index defined as from 25% to 75% twitch recovery of succinylcholine or mivacurium were not altered by pretreatment of esmolol. Plasma cholinesterase activity was not decreased after injection of esmolol 0.5 mg/kg, but decreased by 5% after injection of 1.0 mg/kg (p<0.05). Conclusions: It is unlikely that neuromuscular blocking effects of succinylcholine and mivacurium are prolonged by administration of clinical doses of esmolol (0.5~1.0 mg/kg) due to inhibition of plasma cholinesterase activity in human.
Adult ; Anesthesia ; Cholinesterases ; Humans ; Neuromuscular Agents ; Neuromuscular Blockade ; Plasma ; Succinylcholine* ; Ulnar Nerve

No abstract available.

Pipecuronium bromide is a new biaquaternary steroid-type neuromuscular bloeking agent that is closely similar to pancuronium and vecuronium in chemical structure. The purpose of this study was to evaluate neuromuscular and cardiovascular effects of pipecuronium bromide in patients under enflurane anesthesia in comparison with those of pan- curonium and vecuronium bromide. 35 ASA class I or II adult patients were assigned to one of the following groups; pipecuro- nium 0.08mg/kg(n=15), vecuronium 0.08mg/kg(n=10), and pancuronium 0.1 mg/kg(n=10) as a bolus dose. To investigate cumulative effect of pipecuronium, an additional incremental doses (1 mg) of pipecuronium were given repeatedly to 5 patients in pipecuronium group at every 25% recovery of first twitch height(Ti) of train-of four(TOF) stimulation after administration of in- itial dose. Anesthesia was induced with iv thiopental 5-6 mg/kg and inhalation of 0 (21/min.)-NO(41/ min.)-enflurane(2%), and maintained with O(11/min.)-NA3(21/min.)-enflurane(1-2%). All pa- tients were intubated at 5 minutes after administration of one of these muscle relaxants fol- lowing T> of TOF was depressed more than 95% of control height. Neuromuscular blocking effect was assessed by electromyographic response of hypothenar muscles in response to TOF stimulation of ulnar nerve every 20 seconds at wrist throughout study. Heart rate, systolic and diastolic blood pressures, and mean arterial pressure were noninvasively measured for 20 minutes after adminisf,ration of muscle relaxant. The results obtained were as follows, 1) The onset times from administration of vecuronium, pipecuronium, and paneuronium to 95% depression of T, were 3.4k0.88, 3.8k0.21, and 4.3+/-0.86min. respectively. The onset time of pipecuronium was similar to that of vecuronium but significantly shorter than that of pancur- onium(p<0.05). 2) The duration of action from administration of pipecuronium to 25% reeovery of T was 92.9 +/-15.3min. which was significantly shorter than that of pancuronium(115.2 +/-17.04min., p< 0.05) and longer than that of vecuronium(27.5 +/-5.89 min., p<0.05). 3) Recovery index of pipecuronium was 39.5+7.53min. which was also shorter than that of pancuronium(46.2+/-3.52 min., p < 0.05) and longer than that of vecuronium(13.3+/-1.77 min., p < 0.05). 4) Durations from 10% to 25% recovery of T1 hy additional incremental doses of pipecuronium were not altered significantly by the repeated administration. 5) There were no significant changes on heart rate and blood pressure by 0.08 mg/kg of pipecuronium or vecuronium while heart rate was increased in 21% to 27% for 20 min. after administration of pancuronium. In conclusion, pipecuronium bromide appears to be a useful alternative to pancuronium or vecuronium in relatively long duration of muscular relaxation in patients in whom hemodynamic changes, especially tachycardia, must be avoided.
Adult ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Depression ; Enflurane ; Heart Rate ; Hemodynamics ; Humans ; Inhalation ; Muscles ; Neuromuscular Blockade ; Pancuronium ; Pipecuronium* ; Relaxation ; Tachycardia ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide ; Wrist

Vecuronium induced intense neuromuscular blockade was evaluated in 40 USA class l, ll adult patients using the post tetanic count (PTC) and train-of-four(TOF) methods. All patients were anesthetized with thiopental sodium, nitrous oxide(50%), and enflurane(1~2%). Neuromuscular monitoring commended immediately after administration of thiopental sodium. The ulnar nerve was stimulated using surface electrodes and the mechanical response of the adductor policis muscle recorded using the Acclograph, neuromuscular transmission monitor. TOF nerve stimulation was used every 15s. After supramaximal stimulation was achieved a bolus of vecuronium 0.1mg/kg was injected intravenously. The traches was intubated when TOF response was depressed to 95% or above to control twitch height and the lungs ventilated with a tidal volume of 10ml/kg and a rate of 14 b.p.m. The patients were allocated randomly to two groups of 20 patients each. Patients in control group were allowed to recover TOF response spontaneously, and in PTC group were applied tetanic stimulation(50Hz for 5s) at 7 minutes intervals during no TOF response. In PTC group, the tetanic stimulation was preceded by a 30s period of 1Hz stimulation on each occasion, which was continued after the 3s pause. Duration of no TOF response in each group, and relationship between first post tetanic twitch height of PTC and time to first reaction to TOF nerve stimulation in PTC group were measured. In the results, duration of no TOF response was shortened by tetanic stimulation(p<0.01). There was a close inverse correlation between first post tetanic twitch height or PTC and time to first reaction to TOF nerve stimulation (p<0.01). It was concluded that PTC method appeared to be a valuable supplement to TOF nerve stimulation in assessment and trend for vecuronium induced intense neuromusclular blockade.
Adult ; Electrodes ; Humans ; Lung ; Neuromuscular Blockade* ; Neuromuscular Monitoring ; Thiopental ; Tidal Volume ; Ulnar Nerve ; Vecuronium Bromide*