The clinical applications of free have been extended tremendously in head and neck reconstruction. In a nine-year period, 92 microvascular free flaps were performed to repair the defects following major head and neck ablative surgery. Twenty-one transverse rectus abdominis myocutaneous flaps, 18 radial foream flaps, 15 latissimus dorsi muscle flaps, 12 jejunal flaps, 8 fibular osteocutaneous flaps, 6 rectus abdominis muscle flaps, 6 iliac osteomyocutaneous flaps, 2 groin fasciocutaneous flaps, 1 scapular fasciocutaneous flap, 1 parascapular osteocutaneous flap, 1 tensor fascia lata muscle flap and 1 serratus anterior muscle flap were used for reconstruction. Twenty-five maxillary defects including the orbit or skull base, 16 pharyngoesophageal defects, 15 intraoral defects, 15 mandibular defects, 13 scalp defects, 1 cervical region and 7 other facial region were covered with various free flaps. The overall success rate of the flaps was 95.6%. The complications included total flap loss (3 cases), partial flap loss (1 case), recurrence of primary tumors (15 cases), cerebrospinal fluid leakage (3 cases), fistula formation (3 cases) and infection (5 cases). Superficial temporal artery, facial artery, superior thyroidal artery, lingual artery, occipital artery, transverse cervical artery were commonly used recipient arteries and 7 cases of vein grafts were used if indicated. End to end anastomosis was performed in 84 cases and end to side anastomosis in 8 cases. The average follow-up period was 42 months, ranging from 6 months to 8 years. One patent died during postoperative intensive care due to sepsis and 19 patients died because of recurrence of tumors and underlying medical diseases during the follow-up period. Although free flaps may appear to be riskier than traditional forms of reconstruction, they offer the surgeon a greater spectrum of reconstructive options. Free flap reconstruction also improves the quality of life and minimizes the loss of function. Limitations of the use of free flaps result only from a lack of technical skills and specialized equipment.
Arteries ; Cerebrospinal Fluid ; Fascia Lata ; Fistula ; Follow-Up Studies ; Free Tissue Flaps* ; Groin ; Head* ; Humans ; Critical Care ; Myocutaneous Flap ; Neck* ; Orbit ; Quality of Life ; Rectus Abdominis ; Recurrence ; Scalp ; Sepsis ; Skull Base ; Superficial Back Muscles ; Temporal Arteries ; Thyroid Gland ; Transplants ; Veins

The authors presented a case of gastroschisis with a pedunculated gallbladder embedded in hepatic tissue. The patient was born after fullterm gestation. Due to extensive abdominal wall defect, she succumbed 3 days after birth. There was a pedunculated mass measuring 2.5x1.5x1.5 cm between the liver and distended stomach without any attachment to the liver. The pedicle of the mass was connected to the common bile duct. Cut surface revealed that the mass was an accessory hepatic lobe encircling the gallbladder. The histologic feature of both accessory liver and gallbladder was markedly altered probably due to vascular obstruction. We could find only a single similar case in literlature. That case was associated with Beckwith syndrome and ours was associated with large atrial spetal defect, large patent ductus arteriosus, accessory spleen as well as gastroschisis. The common feature of abdominal wall defect might be a predisposing factor.

BACKGROUND: Obesity is linked to a wide range of respiratory diseases. Several studies have shown that body weight at baseline and weight change were related to pulmonary function. The purpose of this study was to investigate the relationship between change in body mass index (BMI) and pulmonary function in adults. METHODS: Of those aged 40-64 years at baseline who had initially visited the health promotion center at one university-level hospital from January 2000 to December 2002, 499 (men: 309, women: 190) patients revisited the center over a 5-year period up to December 2009 and were enrolled in the study. Subjects were classified into 4 groups- group 1: normal-normal, group 2: normal-obese, group 3: obese-normal, and group 4: obese-obese, based on their BMI at baseline and follow-up. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC were measured by spirometry. RESULTS: Change in FEV1/FVC was significantly associated with change in BMI for men in all 4 groups. Change in FEV1/FVC was significantly different between group 1 and 3 and between group 1 and 4. Changes in FEV1, FVC and FEV1/FVC were significantly associated with change in BMI for women in all 4 groups. Change in FEV1 was significantly different between group 3 and 4, and change in FVC was significantly different between group 1 and 3. CONCLUSIONS: These results suggest that a change in BMI is negatively associated with change in pulmonary function. Obesity itself can be a risk factor for pulmonary dysfunction, and a decrease in BMI through weight reduction could reduce pulmonary dysfunction or improve pulmonary function in adults.
Adult ; Aged ; Body Mass Index ; Body Weight ; Female ; Follow-Up Studies ; Forced Expiratory Volume ; Health Promotion ; Humans ; Male ; Obesity ; Risk Factors ; Vital Capacity ; Weight Loss

OBJECTIVE: This study was carried out to evaluate the effect of the isolation methods of inner cell mass from mouse blastocyst, types of feeder cells and treatment time of mitomycin C on the formation rate of ICM colony. METHODS: The inner cells were isolated by conventional immunosurgery, partial trophoblast dissection with syringe needles and whole blastocyst co-culture method. Commercially available STO and primary cultured mouse embryonic fibroblast (pMEF) feeder cells were used, and mitomycin C was treated for 1, 2 or 3 hours, respectively. The formation rate of ICM colony was observed after isolation of ICM and culture of ICM on the feeder cells for 7 days. RESULT: The ICM colony formation rate on STO were significantly higher in partial trophoblast dissection group (58%) than that in immunosurgery (12%) or whole blastocyst culture (16%) group (p<0.05). The formation rate on pMEF feeder layer was higher in partial trophoblast dissection (88%) and whole blastocyst culture (82%) group than that in immunosurgery (16%) group (p<0.05). When mitomycin C treated to pMEF for 2 hours, the formation rate of 88% was significantly higher than those of other conditions. CONCLUSIONS: Above results showed that the efficient isolation method of ICM from blastocyst was the partial trophoblast dissection and the appropriate treatment time of mitomycin C was 2 hours. However, the subculture of ICM colony and characterization of stem cells should be carried out to confirm the efficacy of the partial trophoblast dissection method.
Animals ; Blastocyst ; Coculture Techniques ; Feeder Cells* ; Fibroblasts ; Mice* ; Mitomycin* ; Needles ; Stem Cells ; Syringes ; Trophoblasts

Computed body tomography has become useful in the diagnosis of pancreatic disease. It was found to be are liable, often specific, and noninvasive method for detecting pancreatitis and extra-pancreatic extension of the pathology. Of eight hundred and seventy-two cases studied for abdominal pathology with EMI-CT 5005 whole body scanner form Oct. 1977 to August 1980, 21 cases were confirmed to be pancreatitis clinically or operatively. The authors reviewed the CT findings of the above cases and the results were as follows; 1. Among twenty-one cases, the acute pancreatitis was 12 cases and the chronic pancreatitis was 9 cases. The sex ratio as 17 males to females. 2. In acute pancreatitis, diffuse enlargement of pancreas (11/12), focal enlargement (1/12), loss of peripancreatic fat plane (9/12), thickening of anterior of pararenal fascia (6/12), and smooth margin ofpancreas (5/12) were observed. 3. In chronic pancreatitis, parenchymal atrophy (7/9), normal size (2/9), loss of peripancreatic fat plane (3/9), thickening of anterior pararenal fascia (1/9), calcification (1/9), smooth margin (2/9), and serrated margin (6/9) were observed. 4. The complications were associated with 7 cases of acute pancreatitis and 1 case of chronic pancreatitis; pseudocyst (6), abscess (2), and fat necrosis (3), The sites of the pseudocyst were lesser sac (2), anterior pararenal space (2), posterior pararenal space (1), subhepatic region (1), greater omentum (1), and intrapancreatic region (2). All of them were associated with acute pancreatitis except one in chronic pancreatitis.
Abscess ; Atrophy ; Diagnosis ; Fascia ; Fat Necrosis ; Female ; Humans ; Male ; Methods ; Omentum ; Pancreas ; Pancreatic Diseases ; Pancreatitis ; Pancreatitis, Chronic ; Pathology ; Peritoneal Cavity ; Sex Ratio

No abstract available.
Adult* ; Atherosclerosis* ; Cholesterol* ; Humans ; Korea*

Tetrodotoxin is a neurotoxin, so gastrointestinal symptoms are very rare ; these described in the literature are merely nausea and vomiting. Severe complications in the gastrointestinal tract caused by tetrodotoxin have not been radiologically reported. US and CT show thickening of the gastric wall and contraction of the lumen, andupper gastrointestinal series show shortening, lobulation and irregularity of the lesser and greater curevature ofthe body and antrum similar to the findings of corrosive gastritis.
Barium ; Eggs* ; Gastritis* ; Gastrointestinal Tract ; Nausea ; Ovum* ; Tetraodontiformes* ; Tetrodotoxin ; Vomiting

CT has an important role in the evaluation of gastric adenocarcinoma. It clearly demonstrates the primary tumor itself and reveals the spread of cancer to adjacent or distant structures. It is therefore useful in the staging of gastric carcinoma, and has proved valuable in the differential diagnosis of this and other gastrictumors. Recent advances in technology such as spiral CT with water ingestion, improve the value of CT. This report describes the characteristic findings of gastric adenocarcinomas by spiral CT, and elucidates its role in the staging of gastric carcinoma.
Adenocarcinoma* ; Diagnosis, Differential ; Eating ; Tomography, Spiral Computed* ; Water

PURPOSE: To determine the preferred method of drinking water before spiral CT scanning of a gastric lesion. MATERIALS AND METHODS: Spiral CT scans of 92 patients with gastric lesion were obtained and evaluated. Patients drank tap water as oral contrast material and were scanned in the prone position; they were divided into two groups according to the method by which water was ingested. Group 1 patients drank 500ml 60 minutes before scanning; 500mL, 30 minutes before scanning; and 500mL just before scanning, while those in group 2 drank 800-1000mL just before scanning. In all cases, precontrast images were obtained, and an additional 300mL of water was given if the stomach was not adequately distended. Postcontrast images were obtained at 35 seconds, 80 seconds and 3 minutes after the start of infusion of contrast material. For 35- and 80-second scans, spiral CT was performed with 5-mm collimation, 7mm/sec table feed, and 5-mm reconstruction interval; for precontrast and 3-minute scans, 10-mm collimation, 10mm/sec table feed, and 10-mm reconstruction interval were used. There were 40 patients in group 1, and 52 in group 2. The images of the two groups were evaluated according to three criteria: gastric distension, mucosal enhancement, and tumor distinction. For each criterion, the images were evaluated by grading; an 'excellent' image scored 3, 'good' 2, 'ordinary' 1, and 'poor' 0. The differences in imaging quality between the two groups were statistically evaluated. Images obtained at 35 and 80 seconds, and at 3 minutes after the start of infusion of contrast material were compared, and the detectability of 18 confirmed cases of early gastric cancer was evaluated. RESULTS: For gastric distension, the mean score was 1.65 in group 1, and 1.81 in group 2 (P=0.33); the corresponding figures for mucosal enhancement were 1.45 and 1.65 (P=0.11), and for tumor distinction, 1.30 and 1.52 (P=0.09). Between the two groups, there was therefore no statistical difference in image quality. With regard to postcontrast images, those obtained after a delay of 35 seconds were best; those obtained at 80 seconds were better than those obtained at 3 minutes. Fifteen of 18 case of early gastric cancer were detected on spiral CT, and the detection rate was 83.8%. CONCLUSION: No statistically significant difference was seen between the two groups, and a single drink of water-just before scanning- is thus preferable to several drinks. Two scans, with images delayed for 35 and 80 seconds after contrast enhancement, are adequate. The use of these methods may improve the image quality of gastric lesions and the detection rate of early gastric cancer.
Drinking Water ; Eating* ; Humans ; Prone Position ; Stomach ; Stomach Neoplasms ; Tomography, Spiral Computed* ; Water*

PURPOSE: The purpose of this study is to assess the efficacy of axial CT imaging and 3D imaging by spiral CTin the detection and evaluation of gastric lesion. MATERIALS AND METHODS: Seventy-seven patients with pathologically-proven gastric lesions underwent axial CT and 3D imaging by spiral CT. There were 49 cases of advanced gastric carcinoma(AGC), 21 of early gastric carcinoma (EGC), three of benign ulcers, three of leiomyomas, and one case of lymphoma. Spiral CT was performed with 3-mm collimation, 4.5 mm/sec table feed, and 1-1.5-mmreconstruction interval after the ingestion of gas. 3D imaging was obtained using the SSD technique, and on analysis a grade was given(excellent, good, poor). Axial CT scan was performed with 5-mm collimation, 7mm/sectable feed, and 5-mm reconstruction interval after the ingestion of water. RESULTS: Among 49 cases of AGC, excellent 3D images were obtained in seven patients (14.3%), good 3D images in 30(61.2%), and poor 3D images in12(24.5%). Among the 12 patients with poor images, the cancers were located at the pyloric antrum in eight cases, were AGC Borrmann type 4 in three cases, and EGC-mimicking lesion in one case. Using axial CT scan alone, Borrmann's classification based tumor morphology were accurately identified in 67.3% of cases, but using 3D imaging, the corresponding figure was 85.7%. In 33 cases receiving surgery, good correlation between axial CT scanand pathology occurred in 72.7% of T class, and 69.7% of N class. Among 21 cases of EGC, excellent 3D images were obtained in three patients (14.3%), good 3D images in 14 (66.7%), and poor 3D images in two (9.5%). The other twocases of EGC were not detected. By axial CT scan, no tumor was detected in four cases, and there were two doubtful cases. 3D images of three benign ulcers were excellent in one case and good in two. 3D images of three leiomyomas and one lymphoma were excellent. CONCLUSION: Combined axial CT imaging and 3D imaging by spiral CT has the potential to accurately diagnose gastric lesions other than AGC Borrmann type 4 or tumors located at the pyloricantrum.
Classification ; Eating ; Humans ; Lymphoma ; Pathology ; Pyloric Antrum ; Silver Sulfadiazine ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Ulcer ; Water