PURPOSE: Due to increasing interest in the treatment of spinal cord injuries, many histopathological studies have been conducted to prove that many neurotrophic factors including growth hormone are important for regeneration of the injured spinal cord. Growth hormone has to be given everyday, however, and this negatively affects compliance in clinical trials. Recently, the invention of sustained release growth hormone (SRGH) that can be given just once a week may both help the regeneration of injured spinal cord and, at the same time, be more compliant and convenient for clinical patients. METHODS: In this study, thirty 7-week-old female Spraque-Dawley rats were subjected to a weight-driven impact spinal cord injury. They were divided into 3 groups and Group I and II were injected with SRGH once a week for 4 weeks; Group I were injected into the injured spinal cord area, while Group II were injected into the peritoneal cavity. Meanwhile, Group III were injected with normal saline solution. The functional outcome was evaluated using the Basso-Beattie-Bresnahan motor rating score and the inclined plane test was done 4 weeks after the first injection. Histopathological examination was performed at the same time and the amount of residual white matter was measured in all groups. RESULTS: After 4 weeks, Groups I and II showed greater improvement than Group III(the control group) in the functional test. In the control group, invasion of atypical phagocytes, axonal degeneration, edema and cavity formation in the posterior site of spinal cord gray matter was observed in histopatholgical examination. The rate of residual white matter in Group III was less than in the other groups. CONCLUSION: Data showed significant functional and histopathological improvement in the groups treated with SRGH into the spinal and peritoneal cavity compared with the control group. SRGH is therefore beneficial because it helps with regeneration of the injured spinal cord and improves the compliance and convenience of patients.
Animals ; Axons ; Compliance ; Edema ; Female ; Growth Hormone ; Humans ; Inventions ; Nerve Growth Factors ; Peritoneal Cavity ; Phagocytes ; Rats ; Regeneration ; Sodium Chloride ; Spinal Cord ; Spinal Cord Injuries

PURPOSE: The repair of complex chest wall defects presents a challenging problem for the reconstructive surgeon. In particular, a free flap is often required when the defect is large, in which case suitable recipient vessels must be found to insure revascularization. The authors report a case of persistent bronchopleural-cutaneous fistula developed after undergoing lobectomy for lung cancer. METHODS: The defect area was repaired using a free vertical rectus abdominis muscle flap revascularized by microvascular anastomosis to the 6th intercostal pedicle. The flap obliterated the right chest cavity, closed the site of empyema drainage, and aided healing of a bronchopleuralcutaneous fistula. RESULTS: The patient has remained healed for 14 months without any postoperative complications or recurrent infection or fistula. CONCLUSION: We suggest that a rectus abdominis musculocutaneus free flap and intercostal pedicle as a recipient could be a useful method for repair of chest defects.
Cutaneous Fistula ; Drainage ; Empyema ; Fistula ; Free Tissue Flaps ; Humans ; Lung ; Muscles ; Postoperative Complications ; Rectus Abdominis ; Thoracic Wall ; Thorax

OBJECTIVES: Fast-setting pozzolan cement (Endocem, Maruchi) was recently developed. The aim of this study was to investigate the effects of various root canal irrigants on the washout of Endocem in comparison to the previously marketed mineral trioxide aggregate (ProRoot; Dentsply) in a furcal perforation model. MATERIALS AND METHODS: ProRoot and Endocem were placed into acrylic molds on moist Oasis. Each mold was then immediately exposed to either physiologic saline, 2.5% sodium hypochlorite (NaOCl), or 2% chlorhexidine (CHX) under gentle shaking for five minutes. Washout testing was performed by scoring scanning electron microscope (SEM) images. RESULTS: Endocem exhibited higher washout resistance compared to ProRoot, especially in the NaOCl group. CONCLUSIONS: These results suggest that Endocem can be considered a useful repair material for furcal perforation, especially in a single-visit scenario.
Acrylic Resins ; Aluminum Compounds ; Calcium Compounds ; Chlorhexidine ; Dental Pulp Cavity* ; Drug Combinations ; Fungi ; Oxides ; Pyrroles ; Root Canal Irrigants* ; Silicates ; Sodium Hypochlorite ; Vinyl Compounds

PURPOSE: Traditionally, titanium miniplate has been used for rigid fixation of mandible fractures. However, the limitations of metal plate have been reported such as hypersensitivity, interference with the cranio-facial growth of growing child, secondary bone resorption around the plate, foreign body reaction, declination of primary callus formation, and bone atrophy, and so forth. Recently, biodegradable miniplate has been introduced and used as an alternative to the metal plate despite of its lower strength. This study evaluated the usefulness and stability of biodegradable plate and screw for treatment of mandible fractures. METHODS: In this study, 61 patients(92 areas) diagnosed as mandible fracture in the last 2 years have been reviewed. We used titanium plate and screw in 32 patients, and biodegradable plate and screw(INION?) in 29 patients. Stability of plates and screws, bony healing process and its side effects were observed by clinical and radiographic assessment. RESULTS: In the titanium material group, one of malocclusion, two of mouth opening limitation, three of pain, three of palpation were shown. The plate of six patients involved in these complications were removed. In the biodegradable group, two of mouth opening limitation, two of pain, one of localized wound infection were shown and one plate was removed secondarily. CONCLUSION: There was no statistical difference between two groups in bony healing and complication rates. Biodegradable implants show efficient stability during initial bone healing and low side effects in long-term follow up periods.
Absorbable Implants ; Atrophy ; Bone Resorption ; Bony Callus ; Child ; Follow-Up Studies ; Foreign-Body Reaction ; Fracture Fixation ; Humans ; Hypersensitivity ; Malocclusion ; Mandible ; Mouth ; Palpation ; Titanium ; Wound Infection

There are few reports about the systemic toxicity of mepivacaine, which is widely used for regional nerve blocks, because of its short onset time and intermediate duration, during or after blockades. We report two cases. In the first, a 70 year-old female with chronic renal failure and hypertension was scheduled for arteriovenous fistula formation under axillary brachial plexus block using 30 ml of 1.5% mepivacaine. In the second, a 69 year-old female with hypertension who was scheduled for total knee replacement under femoral/sciatic nerve block with lateral femoral cutaneous nerve block using 45 ml of 1.5% mepivacaine. Both had an exaggerated hemodynamic response (of increased blood pressure and heart rate) with symptoms and signs of central nervous system excitation not evolving to convulsions, which was induced by mepivacaine during or soon after the blockades. Possible causes and mechanisms of the events are discussed based on the literature.
Arteriovenous Fistula ; Arthroplasty, Replacement, Knee ; Blood Pressure ; Brachial Plexus ; Central Nervous System ; Female ; Femoral Nerve ; Heart ; Hemodynamics ; Humans ; Hypertension ; Kidney Failure, Chronic ; Mepivacaine ; Nerve Block ; Sciatic Nerve ; Seizures

PURPOSE: Pressure sore wound develops inevitably in long-term, immobilized and hospitalized patients. Sore wound infection is common problem and makes healing process difficult. We aimed to identify the pathogens of the purulent discharge in sore wound and to obtain information for appropriate antibiotics through a sensitivity test METHODS: The bacteriologic study was made on 120 cases of patients who admitted or visited our hospital from 2004 January to 2005 December for sore wound treatment. Culture material was collected in BBL transport media with cotton swab and cultured by MacConkey agar plate. The method of MIC by VITEK and Microscan was used for sensitivity test. RESULTS: Among 120 specimens, organisms were isolated from 77(64.2%) cases. Gram positive organisms were cultured in 73 specimens, Gram negative organisms in 46 specemens, and fungi in 2 specimens. Mixed infection by Gram (+) and Gram (-) bacteria were observed in 34 specimens. Among them, S. aureus was the most common isolate in 24(31.2%) patients and 10 (13.0%) S. Aureus isolates were MRSA. The most prevalent Gram-negative organism was Escherichia coli in 20 patients(25.9%). Vancomycin and teicoplanin showed highest sensitivity to Gram-positive organisms and imipenem and amikacin to Gram-negative organisms. CONCLUSION: Pressure sore wound demands consideration of multimodal therapeutic aspects and these findings would be useful informations to physicians, nurses and clinical assistants in understanding the nature of sore wound and selecting appropriate antibiotics.
Agar ; Amikacin ; Anti-Bacterial Agents* ; Bacteria ; Bacteriology* ; Coinfection ; Escherichia coli ; Fungi ; Humans ; Imipenem ; Methicillin-Resistant Staphylococcus aureus ; Pressure Ulcer* ; Teicoplanin ; Vancomycin ; Wound Infection ; Wounds and Injuries

PURPOSE: Pressure sore wound develops inevitably in long-term, immobilized and hospitalized patients. Sore wound infection is common problem and makes healing process difficult. We aimed to identify the pathogens of the purulent discharge in sore wound and to obtain information for appropriate antibiotics through a sensitivity test METHODS: The bacteriologic study was made on 120 cases of patients who admitted or visited our hospital from 2004 January to 2005 December for sore wound treatment. Culture material was collected in BBL transport media with cotton swab and cultured by MacConkey agar plate. The method of MIC by VITEK and Microscan was used for sensitivity test. RESULTS: Among 120 specimens, organisms were isolated from 77(64.2%) cases. Gram positive organisms were cultured in 73 specimens, Gram negative organisms in 46 specemens, and fungi in 2 specimens. Mixed infection by Gram (+) and Gram (-) bacteria were observed in 34 specimens. Among them, S. aureus was the most common isolate in 24(31.2%) patients and 10 (13.0%) S. Aureus isolates were MRSA. The most prevalent Gram-negative organism was Escherichia coli in 20 patients(25.9%). Vancomycin and teicoplanin showed highest sensitivity to Gram-positive organisms and imipenem and amikacin to Gram-negative organisms. CONCLUSION: Pressure sore wound demands consideration of multimodal therapeutic aspects and these findings would be useful informations to physicians, nurses and clinical assistants in understanding the nature of sore wound and selecting appropriate antibiotics.
Agar ; Amikacin ; Anti-Bacterial Agents* ; Bacteria ; Bacteriology* ; Coinfection ; Escherichia coli ; Fungi ; Humans ; Imipenem ; Methicillin-Resistant Staphylococcus aureus ; Pressure Ulcer* ; Teicoplanin ; Vancomycin ; Wound Infection ; Wounds and Injuries

PURPOSE: To assess the feasibility of the da Vinci(R) surgical system in performing gastrectomies for gastric cancer. METHODS: Between 31 December 2007 and 30 June 2008, twenty patients underwent robotic gastrectomies using the da Vinci(R) surgical system for gastric cancer. Retrospectively, clinicopathologic and postoperative surgical outcomes were retrieved from the Stomach Cancer Database at Dong-A University Medical Center. RESULTS: Two patients with serosa invasion required conversion to laparotomy. Seventeen robotic distal gastrectomies and one robotic total gastrectomy were performed. Most patients underwent D1+beta or D2 lymph node dissection. The average number of retrieved lymph nodes was 41. Mean operative time was 271 minutes. Estimated blood loss was 30 ml and mean postoperative hospital stay was 5.1 days. No postoperative complications were reported. CONCLUSION: While application of robotic technology for gastric cancer is technically feasible, problems of long operative times and extremely high costs remain. More randomized studies comparing long-term surgical outcomes between robotic, conventional open, and laparoscopic surgery are needed.
Academic Medical Centers ; Gastrectomy ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Serous Membrane ; Stomach Neoplasms

PURPOSE: The majority of nasal bone fractures have been managed by routine procedure of closed reduction, intranasal packing or intranasal Kirschner wire (K-wire) splinting. But it leaves rooms for many complaints from patients such as pain, rhinorrhea and nasal obstructioon. Another option is, of course, no packing at all. The study was initiated to assess the necessity to pack or splint the nasal bone after routine closed reduction. METHODS: We analysed the medical records of 35 patients with nasal bone fracture who were operated by closed reduction in the last 2 years. We evaluated the postoperative CT scan scores and external deviation criterias 1 month after the operation. RESULTS: The postoperative deviation criteria and postoperative CT scan score were favorable and there were no serious complications using this technique. CONCLUSION: The present study demonstrates that the use of packing or splinting need not be routine in the majority of cases. The risks and discomforts associated with these procedures can often be avoided.
Humans ; Medical Records ; Nasal Bone ; Splints

PURPOSE: Nipple reconstruction is an important step in breast reconstruction after mastectomy. There are considerable number of reconstructive methods developed over the past years. Each of these has not only its own special advantages, but also limitations. Therefore, no single method has become the overwhelming favorite. Sometimes it seems to be compromised when the nipple must be located directly over a linear scar. METHODS: A 48-year-old female patient received a central lumpectomy with circumareolar resection of the nipple areolar complex 4 months ago. The newly designed nipple must be positioned directly astride a scar. We drew two equal-sized rectangular flaps sharing a common limb on a transverse scar and the result was two opposing plow form. Each flap size was about 1.3 cm wide and 2.5 cm long. First we elevated the flap from the distal part at a deep dermal plane, then deepened the level of dissection to raise the dermal-fat flaps. The donor site could be closed directly without any dog-ear deformity. Then we folded down the elevated flaps and loosely sutured skin with nonabsorbable materials. Each flap inner side was approximated side by side. Finally we made new natural nipple with 6mm projection. We applied tattooing in the areola area with micropigmentation device after three months. RESULTS: After ten months of follow-up periods, the nipple projection was stable and symmetric. The nipple projection was 3.1mm, compared with 2.8mm for the opposite nipple. CONCLUSION: Our experiences shows that this double opposing plow flap is a particularly useful and simple technique when there is a traverse scar crossing the center of the proposed nipple area.
Cicatrix ; Congenital Abnormalities ; Extremities ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy ; Mastectomy, Segmental ; Middle Aged ; Nipples* ; Skin ; Tattooing ; Tissue Donors