Malignant hyperthermia still carries a high mortality despite of the increased understanding of the problem involved. A 33 year old relatively healthy male patient was admitted to this hospital via emergency room because of panperitonitis due to peptic ulcer perforation. We experienced acase of malignant hyperthermia which developed 20 minutes after induction of general anesthesia with thiopental sodium, succinylcholine chlovide, halothane, N2O and O2. The body temperature(esophageal) rose altupthy up to 41.2 degrees C and continued as a high fever for about 3 hours. The blood pressure and heart rate also increased and ventricular dyarrhythmia appeared. The etiology, triggering gactors, factors, clinical features, diagnosis treatment and safe anesthesia of malignant hyperthermia are discussed.
Male ; Humans ; Mortality

A 77-year-old man developed diplopia, gait ataxia, and paresthesia. A clinical examination also revealed ophthalmoplegia, facial palsy, ataxia of the limbs and trunk, and reduced deep tender reflexes. Laboratory and electrophysiological studies revealed albuminocytological dissociation and demyelination. He was diagnosed as Miller-Fisher syndrome and received intravenous immunoglobulin therapy. His clinical symptoms deteriorated at 12 weeks after onset. We diagnosed acute-onset chronic inflammatory demyelinating polyradiculoneuropathy, and which the patient recovered from following corticosteroid therapy.
Aged ; Ataxia ; Demyelinating Diseases ; Diplopia ; Extremities ; Facial Paralysis ; Gait Ataxia ; Guillain-Barre Syndrome ; Humans ; Immunization, Passive ; Miller Fisher Syndrome* ; Ophthalmoplegia ; Paresthesia ; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating* ; Reflex

A 77-year-old man developed diplopia, gait ataxia, and paresthesia. A clinical examination also revealed ophthalmoplegia, facial palsy, ataxia of the limbs and trunk, and reduced deep tender reflexes. Laboratory and electrophysiological studies revealed albuminocytological dissociation and demyelination. He was diagnosed as Miller-Fisher syndrome and received intravenous immunoglobulin therapy. His clinical symptoms deteriorated at 12 weeks after onset. We diagnosed acute-onset chronic inflammatory demyelinating polyradiculoneuropathy, and which the patient recovered from following corticosteroid therapy.
Aged ; Ataxia ; Demyelinating Diseases ; Diplopia ; Extremities ; Facial Paralysis ; Gait Ataxia ; Guillain-Barre Syndrome ; Humans ; Immunization, Passive ; Miller Fisher Syndrome* ; Ophthalmoplegia ; Paresthesia ; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating* ; Reflex

The forefoot reconstruction is a challenging field for plastic surgeons. Weight bearing tolerability and stability are important factor of choosing reconstruction methods, but cosmetic aspect has to be considered. 51 year old man visited our clinic with extensive degloving injury on right forefoot by roller. The soft tissue defect started from metatarsal area to the toe tip including nails. We harvested the anterolateral thigh flap and transferred it to the forefoot defect area with nerve coaptation. The flap was successful without skin necrosis or other complications. Secondary flap debulking surgery was performed after ten months from initial operation. Patient was satisfied with functional and cosmetic outcomes. The patient was able to wear shoes and walk with adequate sensory recovery. As there is few report about reconstruction of forefoot soft tissue defects, we report a unique case of the anterolateral thigh innervated free flap reconstruction in degloving injury.
Cosmetics ; Free Tissue Flaps ; Humans ; Metatarsal Bones ; Nails ; Necrosis ; Shoes ; Skin ; Thigh ; Toes ; Weight-Bearing

Prevention of acute rejection in composite tissue allotransplantation without continuous immunosuppression lacks reports in worldwide literature. Recently dendritic cells (DC) gained considerble attention as antigen presenting cells that are also capable of immunologic tolerance induction. This study assesses the effect of alloantigen-pulsed dendritic cells in induction of survival in a rat hindlimb allograft. We performed hindlimb allotransplantation between donor Sprague-Dawley and recipient Fischer344 rats. Recipient derived dendritic cells were harvested from rat whole blood and cultured with anti-inflammatory cytokine IL-10. Then donor-specific alloantigen pulsed dendritic cells were reinjected into subcutaneous tissue before limb transplantation. Groups: I) untreated (n=6), II) DC injected (n=6), III) Immunosuppressant (FK-506, 2 mg/Kg) injected (n=6), IV) DC and immunouppressant injected (n=6). Graft appearance challenges were assessed postoperatively. Observation of graft appearance, H-E staning, immunohistochemical (IHC) study, and confocal immunofluoreiscece were performed postoperatively. Donor antigen pulsed host dendritic cell combined with short-term immunosuppression showed minimal mononuclear cell infiltration, regulator T cell presence, and could prolong limb allograft survival.
Animals ; Antigen-Presenting Cells ; Dendritic Cells ; Extremities ; Hindlimb ; Humans ; Immunosuppression ; Interleukin-10 ; Isoantigens ; Rats ; Rejection (Psychology) ; Subcutaneous Tissue ; Tissue Donors ; Transplantation, Homologous ; Transplants

PURPOSE: Reconstruction of a full thickness defect of the nose is a difficult task for plastic surgeons because the anatomical characteristic, shape, and function of the nose all need to be taken into consideration. Most often, a local flap or a composite graft is used, but for a large defect, reconstruction using free flaps is the most ideal method. In free flap reconstruction, the chondrocutaneous preauricular area can be a suitable donor site. We performed a chondrocutaneous preauricular free flap with an interpositional vascular graft for reconstruction of a nasal ala. METHODS: A 46 year-old male presented to the hospital with a right alar deformity induced by a dog bite. During the surgery, the existing scar tissue was removed and thereby a newly formed full thickness defect was reconstructed using the chondrocutaneous preauricular free flap with an interpositional vascular graft harvested from the descending branch of the lateral femoral circumflex vessel between the facial and superficial temporal vessels of the free flap. RESULTS: The flap survived without flap loss and showed symmetry in its overall shape, contour, texture, and color. The patient was satisfied with the results and the surgery yielded no additional scars at the nasolabial fold area. CONCLUSION: The chondrocutaneous preauricular free flap is a valuable method in reconstruction of full thickness defects of the nose, and using the descending branch of the lateral femoral circumflex vessel as the interpositional vascular graft at the anastomotic site produces reliable results.
Animals ; Bites and Stings ; Cicatrix ; Congenital Abnormalities ; Dogs ; Free Tissue Flaps ; Glycosaminoglycans ; Humans ; Male ; Nasolabial Fold ; Nose ; Nose Deformities, Acquired ; Succinates ; Tissue Donors ; Transplants ; Vascular Grafting

Xanthogranulomatous cholecystitis is an extremely rare benign inflammatory disease of the gall bladder characterized by yellowish focal nodular appearance with tissue necrosis and lipid-containing histiocyte (xanthomacell). Recently, we experienced a case of xanthogranulomatous cholecystitis. A 71-year old woman was admitted with the complaints of RUQ pain for 1 month. On abdominal ultrasound examination, there were diffuse gallbladder wall thickening, echogenic nodule with acoustic shadow, the calculous cholecystiti and the gall badder cancer were strongly suspected and the operation was performed. At operation the gall bladder was marked enlarged and wall thickening with two brownish, oval shaped, smooth surfaced stones. The specimen was revealed a xanthogranulomatous cholecystitis by the pathology.
Acoustics ; Aged ; Cholecystitis* ; Female ; Gallbladder ; Histiocytes ; Humans ; Necrosis ; Pathology ; Ultrasonography ; Urinary Bladder

PURPOSE: This study was done to know the usefulness of fractal analysis when evaluating the radiologic changes after decompression on jaw bone cystic lesions using fractal analysis. MATERIALS AND METHODS: 30cases of cystic lesions were followed up after decompression. Panoramic image was used to observe radiologic changes around the cystic lesion. The part of the panoramic image which showed radiologic change was defined as region of interest(ROI); The fractal dimension of the ROI was calculated using box-counting method. RESULTS: Using sign-rank test, there was a statistically significant difference in fractal dimensions after decompression therapy(P<;0.0001). The fractal dimensions statistically increased after decompression(the median of D:0.12). CONCLUSIONS: The ROI after decompression showed higher fractal dimensions which offer the objective proof of the bone healing around cystic lesions after decompression treatment.
Bone Cysts* ; Decompression* ; Fractals* ; Jaw*

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

Glomus tumors originate in modified vascular smooth muscle cells and are most commonly found in the dermis or subcutis but are rarely observed in the stomach. We report three cases of patients who presented with incidental findings of subepithelial tumors in the stomach. One patient showed a positive cushion sign, and the others showed negative cushion signs. Endoscopic ultrasonography (EUS) demonstrated sharply demarcated hypoechoic tumors with internal hyperechoic spots in the fourth layer of the gastric wall and several hypoechoic halos around the tumors. Contrast-enhanced abdominal computerized tomography (CT) showed homogeneous high enhancement of tumors up to the delayed scan, and one case showed calcification in the tumor. For treatment, laparoscopic wedge resections were performed. Histological and immunochemical analysis of the tumor cells were compatible with glomus tumors. These characteristic findings in EUS and CT seem to be useful for the diagnosis of gastric glomus tumors.
Dermis ; Endosonography ; Glomus Tumor ; Humans ; Incidental Findings ; Muscle, Smooth, Vascular ; Stomach