It has been generally believed that the continuous flow of blood characterised by arterial inflow and venous outflow is essential for the survival of flaps. Since Baek et al.(1985) demonstrated the survival of a flap based on only a single vein without arterial inflow, there have been a lot of reports of successful skin flaps that depend on only venous blood flow. The location of pedicle is one of the important factors on the survival of flaps, but there have not been an effective study on the survival rates of venous island flaps according to their location of pedicles. In this study, we compared the survival rates of proximally based venous island flaps with those of distally based ones and attempted to decrease the difference, if any, in the survival rates between them. Distally or proximally based 4x3 cmvenous island flap, whose pedicle was a marginal branch of central vein, was elevated from the auricular cartilage of New Zealand white rabbit. IN the half of 20 rabbits, superoxide dismutase (SOD, 20,000 U/kg) was injected intravenously 30 minutes and 60 minutes after the flap elevation. On the 7th postoperative day, survival areas of the flaps were measured by image analysis system and the vascular network with the flaps were examined by micro fil cast. 40 flaps were divided as follows: proximally based venous flaps, distally based venous flaps, SOD treated proximally based venous flaps, SOD ttreated distally based venous flaps. The results were as follow: 1. The survival rate(79.39+/-9.24%) of the proximally based venous flaps were significantly higher than those(60.79+/-14.10%) of the distally based ones (p< 0.01). 2. SOD improved survival of the flap significantly (p< 0.05), and there was no statistical difference in the survival rates between proximally based venous flaps and SOD treated distally based venous flaps (p = 0.1785). 3. Revascularization was actively developed in the proximally based venous flaps and those flaps treated with SOD, but was minimal in the distally based venous flaps. These results suggested that the vascular pedicle would rather be located proximally than distally in designing the venous island flaps and that SOD treatment may be effective for the enhancement of survival of venous island flaps, especially in distally based ones.
Ear Cartilage ; New Zealand ; Rabbits ; Skin ; Superoxide Dismutase* ; Superoxides* ; Surgical Flaps ; Survival Rate ; Veins

No abstract available.
Child* ; Dehydration* ; Gastroenteritis* ; Humans

BACKGROUND: Intravenous patient-controlled analgesia (IV-PCA) is a safe and effective method for post-operative pain control. But opioids used in IV-PCA result in some side effects such as respiratory depression, nausea, vomiting, itching and urinary retention. Nalbuphine, an agonist-antagonist, has a considerable analgesic effect without serious complications. This study was designed to evaluate the effectiveness of post-operative pain relief in PCA-administered nalbuphine-ketorolac and morphine-fentanyl-ketorolac. METHODS: Patients scheduled for total abdominal hysterectomy were randomly assigned in a double-blind manner into one of two groups. Group 1 (n=24) and Group 2 (n=28) received nalbuphine-ketorolac or morphine-fentanyl-ketorolac, respectively. All patients received same background infusion rate (2 ml/hr), PCA dose (0.5 ml) and lockout interval (15 min) just after peritoneum closure. And post-operative pain scores were recorded with numerical rating scale (NRS) at 1, 2, 6, 12, 24 and 48 hr after operation. RESULTS: The pain control effect in group 1 was more effective than in group 2. The patients' satisfaction was more superior in group 1. And the number of using PCA button was more frequent in group 2. CONCLUSION: This study suggests that intravenous nalbuphine is an excellent alternative to morphine and fentanyl for postopertive pain control.
Analgesia* ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Fentanyl ; Humans ; Hysterectomy ; Morphine ; Nalbuphine ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peritoneum ; Pruritus ; Respiratory Insufficiency ; Urinary Retention ; Vomiting

Mucoepidermoid earcinoma occurred in about 2% among salivary gland tumor and in about 15% among malignant parotid gland tumor. The tumor occurred usually in elderly persons and arose as innocent-appearing swelling in the parotid gland region with gradual painless enlargement without alarming and it's usual size is less than 2 cm, However, a few of the poorly differentiated neoplasms grew rapidly and were painful and accompanied by facial nerve paralysis in about 15%. But it's prognosis is better than other salivary gland origin. We report a case of typical mucoepidermoid carcinoma of parotid gland origin which is occurred in 15 years old girl. The tumor begins pea sized painless nodule since about 2 years ago, and enlarged gradually to apple size and accompanied by facial nerve paralysis and pain sensation recently. But there was no evidence of tumor in parotid gland itself and no metastasis.
Adolescent ; Aged ; Carcinoma, Mucoepidermoid* ; Facial Nerve ; Female ; Humans ; Neoplasm Metastasis ; Paralysis ; Parotid Gland* ; Peas ; Prognosis ; Salivary Glands ; Sensation

No abstract available.

We report a case of atypical eruption due to chemotherapeutic agent in a 60-year-old man who presented with asymptomatic, erythematous, 0.5cm in diameter, confluent, and elevated papules and plaques confined to the face. The patient was previously diagnosed with small cell carcinoma of the lung with liver metastasis. Two months after the diagnosis, a first course of chemotherapy including etoposide was started. Five days after starting the chemotherapy, the patient developed a facial eruption. Histopathologic examination demonstrated increased epidermal mitotic figures, cells in metaphase arrest, basal cell layer hyperpigmentation, prominent dyskeratosis, and squamous atypia. The most distinctive histologic feature was the presence of starburst cells, which are markedly enlarged pale staining keratinocytes containing small basophilic fragments of nuclear debris haphazardly scattered throughout the cytoplasm in a starburst pattern.
Basophils ; Carcinoma, Small Cell ; Cytoplasm ; Diagnosis ; Drug Therapy ; Etoposide ; Humans ; Hyperpigmentation ; Keratinocytes ; Liver ; Lung ; Metaphase ; Middle Aged ; Neoplasm Metastasis

No abstract available.

No abstract available.
Genetic Therapy*

No abstract available.

While renovating our traditional medical curriculum to integrated curricular system in 1996, we planned to introduce a course of problem-based learning (PBL) on tutorial basis after finishing 14 courses of the integrated medical curriculum for two years. One tutorial group was composed of one tutor and eight students, and 105 students of the second grade were divided into thirteen small tutorial groups. The period of PBL course was two weeks from December 1 to 14 in 1997. There were three interrelated steps for design of PBL course: course preparation, implementation, and evaluation which were conducted by PBL subcommittee consisted of nineteen teachers. Students were exposed to four clinical case modules, and they met in small tutorial room three times per week for two weeks. The PBL programme was evaluated by questionnaire survey method at the end of PBL course. We obtained satisfactory and positive results from reply of faculty and students. Since many teachers participated in planning, implementing, and evaluation of PBL, we could accumulate lots of knowledge and skills regarding the PBL, and it was a good opportunity to train expertise for PBL, test the feasibility changing to PBL curriculum. At this moment, our present integrated medical curriculum will be gradually converted to PBL system totally, and our experience will provide a good aid for other medical schools appling traditional medical curriculum to introduce PBL in their medical education.
Curriculum ; Surveys and Questionnaires ; Education, Medical ; Humans ; Problem-Based Learning* ; Schools, Medical