In the case of crush injury, the failure rate of replantation of free tissue transfer is high. Recently, the freezing of intact and repaired microarteries has been known to relieve spasm without inducing thrombosis in vivo. Therefore, the author thought that the vascular freezing of crushed vein showing only unrecognized endothelial damage after adequate debridement of a damaged vessel can also relieve spasm without inducing thrombosis and improve the patency rate of microvascular anastomosis. In this study, the process of vascular freezing was investigated in veins with acutely damaged endothelium using ethly chloride in a rat model. Two experiments were performed in 30 Sprague-Dawley rats, weighing about 250 gm. In the first experiment, a new crush model was established on the femoral vein of the rats. The degree of vessel injury was evaluated as crush energy. The proper crush energy was determined only by the endothelial damage without inducing thrombosis(0.037 J). In the second experiment, femoral veins were crushed with the energy of 0.037 J on the left side and then frozen after inflicted crush injury with the same energy on the right side. The gross and pathologic findings and patency rates were observed at postoperative day 2, 10 and 30. Patency in both the crushed and crush-freezing group was 100%. Pathlolgic findings in the crush-freezing group were more severe loss of the intima and most parts of the media, as well as cellular depopulation of the media when compared to the crushed group. Microthrombi adherent to the wall were demonstrated in several crush-freezing specimens, but the crush-freezing group showed relief of crush-induced vasopasm and endothelial regeneration. In conclusion, the freezing of microveins with acute endothelial damage relieves spasm without inducing thrombosis. Therefore, this study presents the posslbility of clinical application of vascular freezing in a case of crush injury requiring microvascualr anastomosis.
Animals ; Debridement ; Endothelium* ; Femoral Vein* ; Freezing* ; Models, Animal ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Replantation ; Spasm ; Thrombosis ; Veins

PURPOSE: To describe the associated conditions and clinical significance of lenticulostriate uasculopathy (LSV) as demonstrated by cranial sonography. MATERIALS AND METHODS: We retrospectively studied 77 LSV cases who between January 1994 and January 1996 had undergone cranial sonography for neonatal asphyxia, seizure, or bulging of anterior fontanel. Cranial sonography was performed with 7 MHz real-time linear and sector transducers using an Acuson computed sonography unit ; examinations were performed in sagittal and coronal planes. Twenty-six LSV patients underwent color Doppler studies, and in 24 of these, color signal and arterial pulse spectral wave were detected. LSV was grouped as one of three types, according to echogenicity : type I (less echogenic than sylvian fissure), type II (similar to sylvian fissure), and type III (more echogenic than sylvian fissures). We retrospectively evaluated associated sonographic abnormalities of the brain, and reviewed medical records for associated conditions and neurologic sequelae. Follow-up sonographic examinations were performed in 23 patients. RESULTS: There were 56 type I cases (73 %), 17 of type II (22 %) and 4 of type III (5 %). Cranial sonographic results were normal in 36 cases (47 %) and abnormal in 41(53 %). Forty-eight cases of nonspecific causes and 29 cases of perinatal and acquired causes accounted for associated conditions. The echogenicity of LSV had not changed in 21 of 23 follow-up cases. Neurologic examinations were performed in 18 cases and in 14 of these (78 %) there was no neurologic sequela. CONCLUSION: LSV in basal ganglia may be associated with nonspecific neonatal conditions, in addition to well known perinatal causes.
Asphyxia ; Basal Ganglia ; Basal Ganglia Cerebrovascular Disease* ; Brain* ; Cranial Fontanelles ; Follow-Up Studies ; Humans ; Medical Records ; Neurologic Examination ; Retrospective Studies ; Seizures ; Transducers ; Ultrasonography*

High tension electrical burns affecting the wrist are likely to produce full thickness necrosis of the skin and to damage deep vital structures beneath the eschar, affecting he local tendons, nerves, vessels, even bones and joints which result in serious dysfunction of the hand. An aggressive approach to the treatment of these severe wounds and adequate wound coverage are essential for the successful result. From October 1997 to February 2000, we had treated 23 electrical wrist injuries in 20 patients with free flaps. Among these, 13 anterolateral thigh flaps, 5 forearm flaps, 2 scapular flaps, 2 parascapular flaps, and 1 medial leg flap were executed. About 2-4 weeks after initial injury, we tried free flaps. Preoperative debridement was not carried out. At the time of surgery, debridement of all nonviable tissue was done, but nerves, tendons, and bones were left in place with minimal or no debridement when they had anatomic continuity, regardless of their appearance of viability. In all cases, successful soft tissue coverage and wound healing were achieved, and we obtained the following conclusions. 1. Flap coverage should be executed before damage of the tendons, nerves, vessels. 2. As long as the free flap survives, the infected tendons, nerves, and denuded bone can be salvaged. 3. For later reconstruction of the wrist, fasciocutaneous flap should be preferred to promise tendon gliding and endure several operative procedures.
Burns* ; Debridement ; Forearm ; Free Tissue Flaps* ; Hand ; Humans ; Joints ; Leg ; Necrosis ; Skin ; Surgical Procedures, Operative ; Tendons ; Thigh ; Wound Healing ; Wounds and Injuries ; Wrist Injuries ; Wrist*

Systemic lupus erythematosus (SLE) is a multisystem inflammatory disorder mediated by autoantibodies and immune complexes that exhibit a range of symptoms. Although thirty-five to forty percent of patients with SLE show signs or symptoms of gastrointestinal involvement, acute pancreatitis is an uncommon complication of SLE, and SLE presenting with acute pancreatitis is extremely rare. We report a case of a 28-year-old female SLE patient who initially presented with acute abdominal pain and elevated pancreatic enzyme levels. The patient was diagnosed clinically with acute pancreatitis and then with SLE after further investigations. Her condition improved after high dose steroid therapy.
Abdominal Pain ; Adult ; Antigen-Antibody Complex ; Autoantibodies ; Female ; Humans ; Lupus Erythematosus, Systemic ; Pancreatitis