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

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

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: 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

Isolated fungal soft-tissue infections are uncommon, but may cause severe morbidity or mortality. Aspergillosis infection is rare, but the frequency in increasing over the last two decades. Here, we present a patient with utaneous aspergillosis of his right elbow with unusual clinical and radiological features suggestive of a malignant disease, which remained undiagnosed for an extended period of time. The patient presented with necrotic, black-colored skin ulcerations. We completely removed the skin ulcer with the surrounding erythematous skin lesion, and then we reconstructed the area with thoracodorsal perforator free flap. The biopsy specimen contained septate hyphae with dichotomous branching, which is morphologically consistent with a finding of Aspergillus. After surgery, we initiated antifungal medication therapy with amphotericin B and itraconazole. At the time of follow-up, the elbow with the reconstructed flap had fully healed, and no recurrent disease was found.
Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Aspergillosis/*therapy ; Biopsy ; Humans ; Itraconazole/therapeutic use ; Male ; Middle Aged ; Skin Diseases/*surgery ; *Surgical Flaps ; Treatment Outcome

PURPOSE: The clinical syndrome of unilateral finger ischemia, caused by digital artery occlusions from embolization from the palmar ulnar artery associated with repetitive striking of the palm, has been called the hypothenar hammer syndrome(HHS). We report the case of a man with this unique disease probably caused by manual work. METHODS: A 52-year-old male left-hand dominant manual worker complained of pain and coldness in the left 4,5th finger. On physical examination, there was a tip necrosis and the result of Allen's test was mildly positive(sluggish filling of hand from the ulnar artery). Arteriograms confirmed occlusion of the distal ulnar artery without direct perfusion of the superficial palmar arch and distal digital artery. Surgical bypass with reverse autologous vein grafting was performed between ulnar artery and superficial palmar arch, common digital artery. RESULTS: He had an uneventful postoperative course and has remained asymptomatic for 18 months since discharge. Patency has been confirmed by color doppler with resolution of cold intolerance and successful digital preservation. CONCLUSION: We introduce a very unique pattern of vascular ischemic disease and recommend the arterial bypass with vein interpositional grafting.
Arteries ; Cold Temperature ; Fingers ; Hand ; Humans ; Ischemia ; Male ; Middle Aged ; Necrosis ; Perfusion ; Physical Examination ; Strikes, Employee ; Transplants ; Ulnar Artery ; Veins

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

BACKGROUND: Paradoxical embolism through the patent foramen ovale (PFO) is a well-recognized mechanism for otherwise unexplained ischemic stroke. Although transthoracic contrast echocardiography (TCE) has been used frequently for noninvasive diagnosis of right to left shunt through PFO, its diagnostic accuracy appears limited, especially in patients with poor acoustic window. Since harmonic imaging (HI) can enhance the definition of contrast microbubbles, theoretical advantages of HI in the detection of right to left shunt through PFO using microbubbles can be considered. However, there are few data regarding the diagnostic efficacy of HI in the detection of right to left shunt through PFO. The purpose of this study was to compare the diagnostic value of transthoracic HI in the detection of right to left shunt through PFO in patients with stroke with that of fundamental imaging (FI). Methods: One hundred thirty-six consecutive patients with stroke (82 male, mean age:9) underwent TCE in both HI and FI and transesophageal echocardiography (TEE) during rest and Valsalva maneuver with intravenous administration of agitated saline. PFO was judged to be present if microbubbles appeared in the left atrium within 3 cardiac cycles of their appearance in the right atrium. TEE was regarded as the gold standard for assessing the diagnostic accuracy of TCE. Results: Right to left shunt through PFO was detected in 40 of 136 patients by TEE (29.4%). FI of TCE detected shunt through PFO in only 9 of 136 patients (6.6%). In contrast, HI detected shunt through PFO in 25 of 136 patients (18.4%). The overall sensitivity and specificity of FI and HI for detection of right to left shunt through PFO were 22.5%, 62.5% (p<0.05) and 100%, 100%, respectively. Valsalva maneuver during HI significantly increased the detection rate of shunt through PFO (during rest in 9 and during Valsalva maneuver in 25, p<0.05). CONCLUSION: HI with contrast microbubble injection significantly enhanced the detection of right to left shunt through PFO in patients with ischemic stroke compared with FI by transthoracic approach.
Acoustics ; Administration, Intravenous ; Diagnosis ; Dihydroergotamine ; Echocardiography* ; Echocardiography, Transesophageal ; Embolism, Paradoxical ; Foramen Ovale, Patent* ; Heart Atria ; Humans ; Male ; Microbubbles ; Sensitivity and Specificity ; Stroke ; Valsalva Maneuver

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