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

The decision of surgical treatment for pancreatic cystic lesions may mainly depend on the malignant potential of each lesion. Surgical excision is the most optimal treatment for the mucinous cystic neoplasm due to its high malignant potential. On the other hand, intraductal papillary mucinous neoplasm (IPMN) is divided into main duct type and branch-duct type. Main duct IPMN has high risk of malignant transformation. Therefore, surgical resection has been recommended for all main duct IPMN. Branch duct IPMN has relatively low malignant potential, and usually shows slow progression. A branch duct IPMN that is asymptomatic, less than 3 cm in size and without mural nodules may be followed-up without resection. Serous cystic neoplasm is usually benign in nature. Surgical treatment for serous cystic neoplasm should be considered when definitive diagnosis being uncertain, larger than 4 cm in size, or presence of symptoms. Solid pseudopapillary neoplasm also has low malignant potential which needs surgical excision. Surgical treatment for pancreatic pseudocyst is considered in limited cases with complication, such as infection or bleeding, and which is not controlled with non-surgical treatment. Management strategy for pancreatic cystic lesions should be individualized, and the decision to resect or follow-up a lesion should be based on factors such as the presence or absence of symptoms, patient age, cyst size, grading of malignant potential, location of the lesion, and the surgical risk of the patient.
Follow-Up Studies ; Hand ; Hemorrhage ; Humans ; Mucins ; Pancreas ; Pancreatic Cyst ; Pancreatic Pseudocyst

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

To assess the role of multiple factors in influencing occurrence of ventricular premature complexes after acute myocardial infarction twenty-four hour Holter electrocardiographic tape recording were made in 40 survivors of an acute myocardial infarction 10 to 20days after attack. Ventricular premature complexes in the early post infarction period were not correlated with left ventricular function, age, sex, smoking, diabetes mellitus, previous angina, and previous myocardial infarction. The occurrence of ventricular premature complexes showed a positive correlation with the occurrence of ST-T change. The occurrence of ventricular premature complexes during sleep hours was compared to the awake state. In 22 patients, the incidence of ventricular premature complexes are excluded from analysis, the 22 of patients, or in 76 percent, sleep was associated with a lowered occurrence of ventricular extrasystoles.
Diabetes Mellitus ; Electrocardiography ; Humans ; Incidence ; Infarction ; Myocardial Infarction ; Smoke ; Smoking ; Survivors ; Tape Recording ; Ventricular Function, Left ; Ventricular Premature Complexes*

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