As the use computed tomographic (CT) scanning spread, the diagnosis of blowout fractures of the medial orbital wall increased. Now, the diagnosis of blowout fracture in the medial wall are not uncommon. Conventionally, the surgery of blowout fractures in medial orbital wall was performed by the various approach with external incision. The conventional method had seveal possible disadvantages, including an external scar, incomplete reduction, increased mobidity rate and general anesthesia. Recently, endoscopic reconstruction of the medial orbital wall has provided good functional and cosmetic results. We performed endoscopic transnasal reduction surgery without external incision in 12 cases of medial blowout fracture under local anesthesia. The fractured bony fragments were removed after the intranasal ethmoidectomy and the entrapped medial rectus was released. And then a sheet of silicone late or uncinate process were placed on the fracture site. For the maintain of the position of fractured wall, Merocel packing or urinary ballon catheter were used in orbital fracture site for 1-3 weeks. There were no specific complications related to this procedure. Result of the surgery in all cases were satisfactory. In this article, we discussed the surgical procedure, the benifit of the transnasal endoscopic approach, the indications for surgery, and possible comlications.
Anesthesia, General ; Anesthesia, Local ; Catheters ; Cicatrix ; Diagnosis ; Orbit* ; Orbital Fractures ; Silicones

In order to investigate electrolyte changes in serum and urine diuretic therapy, we studied 98 patients with hypertension not optimally controlled by previous treatment. After we divied the patients into three gorups in randomized trial, group A were given Amiloride 10mg/day, group B were given Dihydrochlorothiazide 50mg/day, group C were given Amiloride 5mg/day combined with Dihydrochlorothiazide 25mg/day for 7 days. Blood pressure and electrolyte changes in serum and urine after diuretic theraphy for 7 days were as follows. 1) Serum sodium concentrations were not significantly changed in all three groups(P>0.05). 2) Serum potassium concentrations were increased in group A and C (P<0.05), but there were no significant changes in group B(P<0.05). 3) Urinary sodium exceretions were increased in all three groups(P<0.05). 4) Urinary potassium excretion were decreased in group A and C (P<0.05), but there were increased in group B (P<0.05). 5) Blood pressure were decreased in all three groups(P<0.05).
Amiloride ; Blood Pressure ; Diuretics* ; Electrolytes* ; Humans ; Hydrochlorothiazide ; Hypertension* ; Potassium ; Sodium

Penile amputation during circumcision is a quite rare event. So far, replantation generally requires microsurgical techniques. Yet herein, we report on the successful replantation of a completely amputated penis; the amputation occurred during the circumcision of a 9-year-old boy, and we did not use microsurgical technique for the replantation.
Amputation ; Child* ; Circumcision, Male* ; Female ; Humans ; Male ; Penile Diseases ; Penis* ; Replantation*

Free neurovascular flap transfers have been widely used for restoration of discriminative sensibility and contour of the finger. The free neurovascular flaps from first web space of the foot is a good treatment option to achieve above two conditions. Fingertip reconstruction with a free toe pulp neurovascular flap, since it was described first in 1979, have been reported a lot. But in most cases. toe pulp flap used first dorsal metatarsal artery as a vascular pedicle. The authors, therefore, carried out four dissections on the cadavers to study first web space neurovascular anatomy for using the dorsal digital artery of the foot as a vascular pedicle. On the basis of the results of this cadaver dissection, we reconstructed posttraumatic soft tissue defect of the fingers with first and second toe pulp free flaps in nine patients from February 1999 to April 2000, and obtained adequate functional recovery as well as satisfactory aesthetic appearance. In our case, maximal flap was 2.5 x 2 cm in size, and the dorsal digital artery of the foot, subcutaneous vein and branch of the dorsal deep peroneal nerve were used as a neurovascular pedicle of the flap. All patients gradually recovered a discriminative sensibility, with static two-point discrimination test between 7 and 16mm and a moving two-point discrimination test between 6 and 13mm. The advantages of this free flap from toe(mainly second toe) are minimal donor site morbidity including arterial system, one-stage operation and shorter rehabilitation period. We consider that the free toe pulp flap using dorsal digital artery of the foot is a useful method for reconstruction of small finger soft tissue defect.
Arteries* ; Cadaver ; Discrimination (Psychology) ; Fingers* ; Foot ; Free Tissue Flaps ; Humans ; Metatarsal Bones ; Peroneal Nerve ; Rehabilitation ; Tissue Donors ; Toes* ; Veins

Benign tumors of the esophagus occur rarely as compared with the incidence of carcinomas. Among the benign tumors of the esophagus such as leiomyoma, lipoma, hemangioma, papilioma. polyp, cystetc. leiomyoma is the most common, although less than 10 percents of leiomyomas of the gastrointestinal tract are found in the esophagus. Most of leiomyomas of the esophagus present as solitary lesions but multiple tumors occur in about 4 percents of cases. Leiomyomas of the esophagus are diagnosed by thorough clinical evaluation, esophagogram and upper gastrofiberscopic examination but histological confirmation requires surgical or necropsy specimens. Occasionally gastrofiberscopic polypectomized specimens are used. We report one case of multiple leiomyomas of the esophagus located in between 25 cm and 40 cm distance from the incisor in a 38-year-old man who complained of vague substernal discomfort for about 10 years. Gastrofiberscopic polypectomized specimen was used for preoperative histological confirmation. The pathologic examination of the specimen showed leiomyoma of the esophagus.
Adult ; Esophagus* ; Gastrointestinal Tract ; Hemangioma ; Humans ; Incidence ; Incisor ; Leiomyoma* ; Lipoma ; Polyps

BACKGROUND: Myasthenia gravis is an autoimmune neuromuscular disorder that shows increased sensitivity to nondepolarizing muscle relaxants. Atracurium is eliminated by Hofmann elimination and ester hydrolysis. We studied the onset and duration of atracurium in patients with myasthenia gravis. METHODS: Ten patients undergoing thymectomy for myasthenia gravis and ten patients of ASA Class I-II without liver, kidney and neuromuscular disease for orthopedic surgical procedures were assigned. Anesthesia was induced with thiopental (4~5 mg/kg) and maintained with inhalation of N2O:O2 (1:1) and enflurane (1.0~2.0 vol%). Atracurium (0.5 mg/kg) was given as a muscle relaxant and then intubation was performed after twitch response was depressed more than 80%. Neuromuscular relaxation was assessed by TOF (T1) at the adductor pollicis with supramaximal stimulation of ulnar nerve at 2 Hz every 12 seconds. The onset and the duration of 5, 25, 50, 75% recovery time of T1 and the recovery index were recorded. RESULTS: Onset of block was shortened and recovery time of 5, 25, 50, 75% and recovery index were prolonged in patients with myasthenia gravis. Conlusions: In patients with myasthenia gravis, atracurium induced rapid onset time and prolonged recovery time of 5, 25, 50, 75% and recovery index.
Anesthesia ; Atracurium* ; Enflurane ; Humans ; Hydrolysis ; Inhalation ; Intubation ; Kidney ; Liver ; Myasthenia Gravis* ; Neuromuscular Diseases ; Orthopedic Procedures ; Relaxation ; Thiopental ; Thymectomy* ; Ulnar Nerve

No abstract available.
Brain* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: It has not been clear whether immunosuppressive therapy favorably influences renal function and proteinuria in IgA nephropathy (IgAN). Angiotensin converting enzyme inhibitor (ACEi) has an anti-proteinuric effect in IgAN. A retrospective study was done to see whether the addition of immunosuppressive therapy to ACEi produces a more excellent anti-proteinuric effect and preserves better renal function than ACEi alone. METHODS: A total of 49 patients with proteinuria>1.0 g/day and serum creatinine concentrations<1.5 mg/dL were followed-up from at least 1 year to 9 years. Among them, 25 patients were treated with the combination of cyclophosphamide, prednisolone and ACEi while the other 24 were treated with ACEi alone. RESULTS: The combination therapy or ACEi alone both reduced proteinuria with significant value (the combination group: from 5.74+/-5.08 to 2.29+/-2.77 g/day, ACEi group: from 3.85+/-2.54 to 1.68+/-1.91 g/day), while no significant differences in reduction of proteinuria were noticed between the two groups. There was no significant elevation of serum creatinine in both groups during follow-up (the combination group: from 0.91+/-0.20 to 1.03+/-0.38 mg/dL, ACEi group: from 0.93+/-0.27 to 0.99+/-0.37 mg/dL). This study showed no significant differences in the change in slope of 1/serum creatinine levels during the follow-up period between the two groups. CONCLUSION: We conclude that immunosuppressive therapy may not be beneficial in patients with proteinuric IgAN. ACEi may be a valuable therapeutic agent avoiding serious side effects of immunosuppressive agents.
Adolescent ; Adult ; Aged ; Angiotensin-Converting Enzyme Inhibitors/*administration & dosage ; Comparative Study ; Cyclophosphamide/*administration & dosage ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Glomerulonephritis, IGA/diagnosis/*drug therapy ; Human ; Immunosuppressive Agents/*administration & dosage ; Kidney Function Tests ; Male ; Middle Age ; Prednisolone/*administration & dosage ; Probability ; Retrospective Studies ; Severity of Illness Index ; Statistics, Nonparametric ; Treatment Outcome

Purpose: We investigated the effects of sex steroids on the maxi-K channel activities of the single smooth muscle cells of the human vas deferens. Materials and Methods: Human vas deferens cells were isolated using proteolytic enzymes (collagense and papain), and then they were employed for an electrophysiological study with using the inside-out patch clamp configurations. The intracellular calcium concentrations were adjusted between 0.1mum to 1mum, and the membrane potentials were depolarized. Results: The maxi-K channels were identified by their single channel conductance and calcium dependency. The application of 10ng/dl estrogen induced a significant increment of the maxi-K channel activities. The effects were not affected by the change of the intracellular calcium concentration. The other sex steroids (progesterone and testosterone) rarely affected the maxi-K channel activities. Conclusions: Estrogen has stimulatory effects on the maxi-K channel activity of human vas deferens. This suggests that estrogen may relax the human vas deferens via maxi-K channel activation.
Calcium ; Estrogens ; Humans* ; Large-Conductance Calcium-Activated Potassium Channels ; Membrane Potentials ; Myocytes, Smooth Muscle ; Peptide Hydrolases ; Steroids* ; Vas Deferens*

BACKGROUND/AIMS: Guidelines for current postoperative colonoscopic surveillance are not specified in colorectal cancer (CRC) patients with synchronous adenoma (SA). We performed this retrospective study to determine the postoperative colonoscopic surveillance interval for the CRC patients with SA. METHODS: One hundred and twenty-four CRC patients with SA (SA-group) and the same number of patients without SA (NSA-group) were selected from our database. Two groups were matched by the stage of CRC. Median colonoscopic surveillance period was 55 (12-99) months. The colonoscopic surveillance frequency and interval were similar between the two groups. RESULTS: Mean age was higher and male was more frequent in SA-group than NSA-group (p= 0.0001). The incidence of missed adenoma, advanced missed adenoma and metachronous adenoma (MA) were higher in SA-group (30.8% vs. 5.8% at 1st yr., p=0.0001; 4.4% vs. 0%, p=0.0001; 31.1% vs. 9.1% at 2nd yr., p=0.016) during the first consecutive two years of surveillance. The MA- and advanced-MA-free survival rate were lower in SA-group (24.6% vs. 6.6%, p=0.0001; 4.1% vs. 0%, p=0.02) during three years after surgery. Dysplasia of the SA (p=0.04; OR, 110.3; 95% CI, 1.13-10742.6) and presence of missed adenoma (p=0.036; OR, 43.6; 95% CI, 1.28-1490.1) were risk factors for the advanced MA on a multivariate analysis in SA-group. CONCLUSIONS: Postoperative colonoscopic surveillance at first year after surgery is warranted in CRC patients with SA.
Adenoma/diagnosis/*surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoma/diagnosis/*surgery ; Colonic Neoplasms/diagnosis/*surgery ; *Colonoscopy ; Colorectal Neoplasms/diagnosis/*surgery ; Disease-Free Survival ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary/diagnosis/*surgery