BACKGROUND: Nitric oxide (NO) is a simple molecule with a complex involvement in a wide variety of biologic functions. However, whether NO protects or aggravates brain injury is still controversial. This study was conducted to determine the effect of nitric oxide on the formation of brain edema resulting from a focal cryogenic injury in rats. METHODS: Thirty nine Sprague-Dawley rats (200~250 gm) were allowed food and water ad libitum. Anesthesia was induced in a specially designed plastic box with 5% halothane in oxygen. In experiment I (24 rats), animals were divided randomly into eight group (3 rats in each group) according to the decapitation time in control, 15, 30, 45, 60, 90, 120, and 180 min. Cryogenic injury was made by pouring liquid nitrogen to exposed temporo-parietal area through metal funnel for 60 seconds. After cryogenic injury, brain was quickly removed and cerebral hemispheres were seperated. Separated cerebral hemispheres were dried in a drying oven for 7 days at 60 degrees C. Cerebral water content was assessed by dry-weight method. In experiment II (15 rats), one subgroup (n=8) was control group, normal saline 0.5 ml was injected intraperitoneally 30 minutes before injury. the other (n=7) was experimental group, and a competitive nitiric oxide synthase inhibitor, N-nitro-L-arginine methyl ester (L-NAME), was given intraperitoneally 30 minutes before injury in a dose of 20 mg/kg. Body temperature was monitored during whole experiment. Ninety minutes after injury, brain was quickly removed and cerebral hemispheres were seperated. The cerebral water content of separated cerebral hemisphere was assessed by dry-weight method. RESULTS: In time courses of cryogenic brain edema of experiment I, the amount of brain edema was increased till 90 minutes after cryogenic brain injury and then decreased. In L-NAME group of ex-periment II, the amount of cerebral edema was not changed significantly (p<0.05). But, there was a tendency of decrease in brain edema formation in L-NAME group than control group. CONCLUSION: It was not proved that nitric oxide had a major role in the edema formation aftercryogenic brain injury, but it still seems that nitric oxide has at least partly involved in the pathogenesis of cerebral edema resulting from traumatic brain injury.
Anesthesia ; Animals ; Body Temperature ; Brain Edema ; Brain Injuries* ; Brain* ; Cerebrum ; Decapitation ; Edema* ; Halothane ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Nitrogen ; Oxygen ; Plastics ; Rats* ; Rats, Sprague-Dawley

BACKGOUND: Transfusion of red blood cells is a life saving measure in the management of a variety of surgical conditions. A guideline for blood transfusion during elective surgical procedure is necessary to reduce the risks of transfusion-associated complications, excessive blood bank workload, excessive blood request and overtransfusion, and the cost. From this, a program of quality assessment was adopted to improve blood transfusion practice and to establish the guideline for blood transfusion in elective surgery at Pusan National University Hospital. METHODS: Fifty-six patients undergoing elective surgery was divided 2 groups. Transfusion (T) group was 18 persons. Non-transfusion (NT) group was 38 persons. The preoperative, pre-transfusion, postoperative, and post-transfusion hemoglobin (Hb), hematocrit, mean arterial blood pressure (MAP), heart rate (HR), average amount of transfused red blood cell units, allowable blood loss, and the amount of infused crystalloids and colloids was estimated for 9 months in Pusan National University Hospital. RESULTS: There were no significant differences in Hb between T & NT group. Hb decreased significantly until postoperative 3rd day in NT group. Platelet count decreased in NT group on postop. 3rd day. There were no significant differences in MAP & HR. One-ninth of T group was overestimated blood loss & 18.4% of NT group was underestimated blood loss. One-third of transfusion patient were overtransfused & 36.2% of transfused RBC was unnecessary. Nearly 90% of patient was transfused packed RBC with FFP concurrently. CONCLUSIONS: To minimize overtransfusion, transfusion based on intraoperative hematocrit is necessary. If possible, single use of packed RBC is recommended when the blood loss is below allowable blood loss. In massive bleeding above allowable blood loss, combined administration of FFP and packed RBC or transfusion of whole blood will be better.
Arterial Pressure ; Blood Banks ; Blood Transfusion* ; Busan ; Colloids ; Erythrocytes ; Heart Rate ; Hematocrit ; Hemorrhage ; Humans ; Operating Rooms* ; Platelet Count ; Surgical Procedures, Elective

Cochlear implant extrusion, which is a common complication of cochlear implants, is generally repaired by a well visualized soft-tissue flap. A 61-year-old female patient with a medical history of schizophrenia who had a skin ulcer that caused cochlear implant extrusion, but that would be a stronger statement was referred to our department for removal of the implant and reconstruction of the resultant scalp defect. Accordingly, the broad defect was covered via rotation of a temporoparietal fascia flap (TPFF) using the superficial temporal artery, with the pedicle in the preauricular region as the pivot point. Coverage of TPFF was achieved with a split-thickness skin graft using the scalp as the donor site, which led to a quick recovery after the operation and satisfactory results in terms of aesthetics. This case suggests that a TPFF might be used as a flexible flap with low donor site morbidity for reconstructing cases of cochlear implant extrusion accompanied by a large full-layer scalp defect.
Cochlear Implants ; Esthetics ; Fascia ; Female ; Humans ; Middle Aged ; Reconstructive Surgical Procedures ; Scalp ; Schizophrenia ; Skin Ulcer ; Skin ; Surgical Flaps ; Temporal Arteries ; Tissue Donors ; Transplants

Recent studies have reported on the reconstruction of oral mucosal defects using acellular dermal matrix (ADM). This case report describes the reconstruction of a soft-palate mucosal defect using ADM. A 43-year-old man developed a 2.5 cm × 3 cm soft-palate mucosal defect after the removal of a lump on the soft palate andreconstructed the defect using ADM without further complications. Reconstruction of the soft palate with ADM could be more convenient than traditional methods including primary closure, skin graft, and local or free flap without complications.
Acellular Dermis ; Adenoma, Pleomorphic ; Adult ; Free Tissue Flaps ; Humans ; Palate, Soft ; Skin ; Transplants