Amputation through the epiphyseal plate is very rare. Authors experienced only one case of ankle amputation through the epiphyseal plate in one huadred seventeen replantation cases during last seven years. It can make severe growth disturbance after replantation especially if the bone shortening is carried out at epiphyseal plate. Authors have developed new idea to make boae shortening during replantation with preservation of the epiphyseal plate in amputation through the epiphyseal plate in three years old female. It is, so called, double osteotomy shortening. Bone shortening is performed at 5cm above amputated epipyaeal plate to avoid further damage in epiphyseal plate, and a bone segment 3cm in length is resected,by double osteotomy shortening technique. After then, bone reduction and internal fixation is followed. With above technique, authors succeeded in replantation without further damage in epiphysis. In three years and ten months follow-up, bony growth in replanted tibia shows normal pattern, and epiphyseal plate in replanted site is working and remained open. The patient can walk without pain, and motor-sensory function have almost completely recoverered.
Amputation ; Ankle ; Epiphyses ; Female ; Follow-Up Studies ; Growth Plate ; Humans ; Osteotomy ; Replantation ; Tibia

The distribution of enkephalin, dynorphin, substance P and neurotensin in the periaqueductal gray[PAG] has been well established by immunohistochemical methods. However, there is little information about the regional distribution of these neuropeptide mRNA-containing neurons in the PAG. The present study was undertaken [1] to elucidate the distribution of these neuropeptide mRNA-containing neurons and to determine of the PAG, [2] to know how peptide expression relates to the proposed functional subdivisions of the PAG and [3] to know how neuropeptide mRNA levels in the PAG change following peripheral neuropathy The results obtained are as follows ; 1. Preproenkephalin[pENK] mRNA-containing neurons are found mostly in the ventrolateral portion at all levels of the PAG. 2. Prodynorphin[pDYN] mRNA-containing neurons are concentrated mostly in the ventrolateral portion at the caudal level of the PAG. 3. Preprotachykinin[pTAK] mRNA-containing neurons are localized mainly in the ventrolateral portion at all levels of the PAG. There is small numbers of pTAK mRNA-containing neurons in the dorsolateral and dorsal portion at all levels of the PAG. 4. Proneurotensin[pNT] mRNA-containing neurons are concentrated mostly in the medial part of ventrolateral portion of the caudal and mid PAG. 5. Peripheral neuropathy induces an increase of pNT mRNA levels in the PAG, while pENK, pDYN and pTAK mRNAs levels show no change. The present results indicate that the pENK, pDYN, pTAK or pNT mRNA-containing neurons are found mainly in the ventrolateral PAG, the area where analgesia is most easily produced and that neurotensin in the PAG may play an important role in modulating chronic neuropathic pain.
Analgesia ; Animals ; Dynorphins ; Enkephalins ; Gene Expression* ; In Situ Hybridization ; Neuralgia* ; Neurons* ; Neuropeptides* ; Neurotensin ; Periaqueductal Gray* ; Peripheral Nervous System Diseases ; Rats* ; RNA, Messenger ; Substance P

PURPOSE: The purpose of this study was to analyze the subjectivity of contents related to death as a nursing curriculum subject for nurses and students. METHOD: The Q-methodology which provides a method for analyzing the subjectivity of each items was used. The 34 selected Q-statements sorted by each of the 36 participants were classified into a normal distribution by using a 9 point scale. The collected data were analyzed using the QUANL PC program. RESULTS: Four types of content related to death nursing curriculum were identified. Type I is the psychologically sympathetic type, Type II is the clinical based experience type, Type III is the physically comfort seeking type, and Type IV is the human-understanding oriented type. CONCLUSION: The results of this study show that different approaches to education are needed to address the four types of content related to death as a nursing curriculum subject. Both contents and characteristics need to be considered.
Curriculum* ; Education ; Humans ; Nursing*

A case of the brain death confirmed by isotope angiogrphy is described. Isotope angiography is a simple and noninvasive technic compared to carotid angiography, and is recommended as a reliable test for the diagnosis of brain death.
Angiography* ; Brain Death* ; Brain* ; Diagnosis

A case of the brain death confirmed by isotope angiogrphy is described. Isotope angiography is a simple and noninvasive technic compared to carotid angiography, and is recommended as a reliable test for the diagnosis of brain death.
Angiography* ; Brain Death* ; Brain* ; Diagnosis

Proliferative scarring in the form of keloids and hypertrophic scars continues to be a clinical problem for some patients. The lack of an animal model for such scarring has been an obstacle to studying the biology and effective therapy of these entities. Consequently we created an accurate reproductive animal model to systematically study them. Human proliferative scars were explanted into flaps based on isolated vascular pedicles in congenitally rats. We compared the procollagen type III peptide levels of proliferative scar tissue before and after explanting. The procollagen type III peptide levels of explanted proliferative scar tissue remained increased as before explanting. Histological analysis of the explanted proliferative scar tissue revealed that all explants retained their original histotypic character even after 1 year. We could also retain the volume of implanted proliferative scar for 1 year and studied in vitro cellular proliferation. Fibroblast cultures from explanted scars demonstrated less aggressive growth characteristic than those from original surgical specimens. The advantages of this animal model are as follows: 1. The explants retain their histotypical character for a long period. 2. Placement of the explants outside the dorsum of a nude rat makes serial observation and measurement easier. 3. Agents under test can be injected into the explants through a catheter inserted into a single pedicle of island flap without the possibility of spreading systematically.
Animals* ; Biology ; Catheters ; Cell Proliferation ; Cicatrix* ; Cicatrix, Hypertrophic ; Collagen Type III ; Fibroblasts ; Humans ; Keloid ; Models, Animal* ; Rats ; Rats, Nude

Among the complications of intracranial surgery, postoperative hemorrhage remote from the operative site is rare, especially when it occurs in the cerebellum after surgery involving the supratentorial region. We report three cases of cerebellar hemorrhage after supratentorial surgery : 1) A 66-year-old man with subdural hygroma in both frontotemporal areas ; 2) A 56-year-old man with chronic subdural hematoma in the left frontotemporal area ; 3) A 39-year-old woman with aneurysms at the right middle cerebral artery bifurcation and basilar tip. The possible etiologies of cerebellar hemorrhage in the three cases presented here were reviewed. We speculate that when the patient is in the supine position with head rotated and extended, the displacement of the cerebellum causes stretching of the superior vermian veins and their tributaries, resulting in tearing of these vessels, and that a sudden decrease in intracranial pressure may accelerate this process. To prevent this complication, meticulous perioperative management of the patient is essential.
Adult ; Aged ; Aneurysm ; Cerebellum ; Female ; Head ; Hematoma, Subdural, Chronic ; Hemorrhage* ; Humans ; Intracranial Pressure ; Middle Aged ; Middle Cerebral Artery ; Postoperative Complications ; Postoperative Hemorrhage ; Subdural Effusion ; Supine Position ; Veins

Although sacrococcygeal mass is rare and usually found in infants or children, adolescent or adult patients with protruding mass in sacrococcygeal region occasionally come to us simply for a cosmetic problem. In this situation, even though there is no definite neurological deficit, it should be evaluated whether or not the underlying bony pathology or dural defect exists. Few cases about the sacrococcygeal mass have been reported in adults. We reviewed our cases including preoperative evaluation methods and postoperative diagnosis. From March, 1993 to February, 1997, we experienced 6 adult patients with sacrococcygeal mass and no neurological abnormality. Preoperative evaluation were made by plain X-ray, myelogram, computed tomography(CT), and magnetic resonance imaging (MRI), as needed. Postoperative diagnoses were 2 meningoceles, 2 lipomyelomeningoceles, 1 desmoid tumor, and 1 teratoma. From our experiences, CT or MRI is essential to evaluate the sacrococcygeal mass preoperatively. These methods can visualize the precise anatomic location and extent of the mass, its relation to the spinal cord, and associated bony abnormalities. MRI is superior to CT, especially in defining the nature of the mass and involvement of the spinal cord. Conclusively, even a simple mass in the sacrococcygeal region in adults needs MRI or CT evaluation, and MRI is the most valuable method of evaluating the mass preoperatively and provides important information to establish a treatment plan.
Adolescent ; Adult* ; Child ; Diagnosis ; Fibromatosis, Aggressive ; Humans ; Infant ; Magnetic Resonance Imaging ; Meningocele ; Pathology ; Sacrococcygeal Region* ; Spinal Cord ; Teratoma

This study was undertaken to compare the effects of furosemide on the serum concentration of sodium and osmolality after transurethral prostatic resection(TURP) using cytal solution, and to determine the adequate time of administration of frurosemide. At the end of prostatic resection, 15 patients were allocated randomly to receive furosemide (furosemide group) and were compared with 15 patients without administration of furosemide (control group). There was no difference in mean serum concentation of sodium between two groups. Serum osmolality in furosemide group was significantly increased as compared with control group one hour after operation. So cytal solution used during staged TURP and short operation within one hour do not affect serum corcentration of sodium and administration of furosemide is not associated with a change in serum concentration of sodium. But furosemide meaningfully increases the serum osmolality and it is more effective to administer it with administration at the end of prostatic reseetion.
Furosemide* ; Humans ; Hyponatremia ; Osmolar Concentration* ; Sodium* ; Transurethral Resection of Prostate*

To investigate the effects of prostaglandin E1(PGX1) in prevention of proliferative scar formation, we cultured fibroblasts of normal skin (NS), hypertrophic scar (HS) and keloid (KL) tissues obtained from patients. We have compared type I collagenase production of cultured fibroblasts from normal skin, hypertrophic scar, and keloid tissues under various concentrations of PGE1. Our results demonstrate that type I collagenase production was significantly increased after addition of PGE1 in HS and KL, but not NS. Type I collagenase production of HS and KL fibroblasts were increased similarly in 10M and 10M of PGE1 and maximally increased in the concentration of 10M. This promotive effects of PGE1 on the production of type I collagenase was larger in KL than in HS. These results also suggest that PGE1 may play the promotive effects on type I collagenase production in dose-dependent manner. PGE1 may have a role in the prevention of hypertrophic scar and keloid by enhancing the production of type I collagenase of HS and KL fibroblasts. The promotive effects of PGE1 on type I collagenase production was variable depending on its concentration, and its effects was maximum in certain optimal condition. The maximally effective concentration of PGE1 in the prevention of proliferative scar formation should be searched in further investigations for clinical use.
Alprostadil ; Cicatrix ; Cicatrix, Hypertrophic* ; Collagenases* ; Fibroblasts* ; Humans ; Keloid* ; RNA, Messenger* ; Skin