With the continuous development of diagnostic techniques of precancerous lesion and an improved patient-transfer system, it is unusual to examine patients who have a life-threating malignant skin lesion. However it is still a problem in some far-advanced inoperable skin tumors which have been neglected and have become aggravated, Another problem in oncologic surgery is previous irradiation around a lesion. The only effective way to treat these lesions is to excise widely and cover with an appropriate free flap. But in such conditions, selection of recipient vessel is not easy. Many surgeons have used vein graft as the conduit from a distant non-radiated vessel to the free flap. This technique requires a long segment of vein for anastomosing both the artery and vein. We used intra-lesional vessels as the recipient vessel of the free flap, which were suspiciously damaged by irradiation and malignant cell infiltration. The guidelines include: 1) malignancy-infiltrated vessels are to be dissected until a clear field is obtained under a frozen section 2) irradiated vessel can be used only if active spurting is present without intraluminal thrombosis. All of our case obtained satisfactory results in all cases except one of irradiated squamous cell carcinoma at inguinal area whose gracilis myocutaneous free flap loss was in 10%. But even this case, the cause of partial loss of the flap may not be due to a vascular problem but an internal failure of the flap. We concluded, that carefully selected intra-lesional vessels, although they may be damaged by irradiation or malignant cell infiltration can be used as the recipient vessels of free flaps.
Arteries ; Carcinoma, Squamous Cell ; Free Tissue Flaps* ; Frozen Sections ; Humans ; Skin ; Thrombosis ; Transplants ; Veins

The finger-tip is a specially-differentiated end structure of the human body in anatomic aspect. Although it is covered with thick dermis and a heavily-cornified epithelial layer, the finger-tip represents tremendous sensory perception because of dense sensory nerve endings. This highly sensitive skin is attached to the phalangeal bone or fascia and stabilizd during grip or pinch by the fascial septa, which form compartments of fat pads in the pulp tissue. In addition to its functional aspect, the finger tip plays an important cosmetic role because it is an exposed area like the face. So, when reconstructing finger-tips, especially the thumb or radial side of the index finger, one must take into account both the functional and esthetic results. In this study, 8 cases of great toe pulp sensory free flaps for fresh amputations (n=4) and previously reconstructed wounds (n=4) are included. In previously-reconstructedcases cases, all of them complained of incomplete recovery of sensation or cosmetic dissatifaction. The fingers covered with flaps were the index finger (n=5), ring finger (n=2), and thumb (n=1). The mean size of flaps was 3 x 1.9 cm and all of the flaps survived without significant complications, except 1 case of venous insufficiency. Sensory complications, except 1 case of venous insufficiency. Sensory perception was detected within 4 months and improved gradually during the follow-up period to 10.5 mm/8 mm in static/moving two-point discrimination test. Even though, some patients complained of postoperative paresthesia including cold intolerance (37.5%), pain (25%) and hyperesthesia (12.5%), the great toe pulp sensory flap is an aesthetically superior and sensuously more satisfactory alternative to other reconstructive procedures for fingertip defects.
Adipose Tissue ; Amputation ; Dermis ; Discrimination (Psychology) ; Fascia ; Fingers ; Follow-Up Studies ; Free Tissue Flaps* ; Hand Strength ; Human Body ; Humans ; Hyperesthesia ; Paresthesia ; Sensation ; Sensory Receptor Cells ; Skin ; Thumb ; Toes* ; Venous Insufficiency ; Wounds and Injuries

PURPOSE: To investigate the effect of triamcinolone acetonide (TA) on the survival, nitric oxide (NO) production, and migration of cultured human trabecular meshwork (TM) cells. METHODS: After exposure to TA, indomethacin, and dexamethasone for 2 days, the survival and nitrite production of the primarily cultured human TM cells were assessed with MTT and Griess assays respectively. The effect of co-exposure to the NO donor, sodium nitroprusside, was also assessed. A migration assay was done to evaluate the effect of TA on the activity of TM cells. RESULTS: Cellular survival increased after exposure to TA at low concentration but decreased at high concentration. TA decreased the production of NO significantly (p<0.05). Exposure to indomethacin and dexamethasone revealed similar results. TA reversibly inhibited the migration of TM cells. CONCLUSIONS: TA decreases the production of NO and inhibits the migration of TM cells. TA at high concentration decreases cellular survival accompanied with decreased NO production. These effects of TA on TM cells may result in the elevation of intraocular pressure.
Dexamethasone ; Humans ; Indomethacin ; Intraocular Pressure ; Nitric Oxide ; Nitroprusside ; Tissue Donors ; Trabecular Meshwork* ; Triamcinolone Acetonide* ; Triamcinolone*

BACKGROUND: It is known that low birth weight is a risk factor for poor outcome in cardiac surgery for many cardiac defects.We reviewed our recent surgical experiences on congenital heart defect (other than patent ductus arteriosus)in low birth wei ght babi es.Material and METHOD: From September 1994 to February 2001,31 consecutive infants weighing 2500 g or less underwent cardiac surgery with (OHS group n=12)or without cardiopulmonary bypass (CHS group n=19).A retrospective study was carried out to evaluate short-and intermediate-term outcome.Mean gestational age and age at operation were 36.9 weeks(range,32.3-42weeks)and 32.1days (range,0-87days)respectively.Mean body weight at birth and operation were 1972g (range,1100-2500g)and 2105g (range,1450-2500 g)respectively.There was no difference between the two groups in age and body weight.Defects included ventricular septal defect (VSD)(n=3),VSD with arch anomaly (n=2),total anomalous pulmonary venous return (n=2),transposition of the great arteries (TGA)(n=2),truncus arteriosus (n=2),and univentricular heart with cor triatriatum (n=1)in OHS group,and coarctation of aorta (n=7),tetralogy of Fallot (TOF)(n=3),TOF with pulmonary atresia (n=3), multiple muscular VSDs (n=1),double outlet right ventricle (n=1),pulmonary atresia with intact ventricular septum (n=2),tricuspid atresia (n=1),and TGA with multiple VSD (n=1)in CHS group.13 patients (41.9%)were intubated pre-operatively. RESULT: There were 4 early deaths (<30 days);1 (8.3%)in OHS group and 3 (15.8%)in non-OHS group.All these early deaths were related to the pulmonary artery banding(PAB).There was no operative mortality in infants undergoing complete repair and palliative operations other than PAB.Delayed sternal closure was required in 3 patients.Prolonged postoperative mechanical ventilation (>7days)was required in 7 patients (58.3%)in OHS and 7 (38.8%)in CHS group.Late mortality occurred in 3 patients,two of which were non-cardiac.A patient in OHS group was documented to have neurologic sequelae.All the survivors except two are in NYHA class I. CONCLUSION: Complete repair and palliative operations other than PAB can be performed in low birth weight infants with low operative mortality and an acceptable intermediate-term result.However,about a half of the patients required long-term postoperative mechanical ventilation.
Aortic Coarctation ; Arteries ; Body Weight ; Cardiopulmonary Bypass ; Cor Triatriatum ; Gestational Age ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Mortality ; Parturition ; Pulmonary Artery ; Pulmonary Atresia ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Scimitar Syndrome ; Survivors ; Thoracic Surgery* ; Ventricular Septum

The goal of cleft lip surgery is to reconstruct normal shape of the lip. To acomplish this goal, various operative method were contrived and concept of the method decided the shape of reconstructed lips. According to the operative result, some operative methods were disappeared or have been developed with a little modifiation. Traditional Millard's rotation-advancement method for unilateral cleft lip patients is largely accepted and developed as proper method for acquiring these functional and anatomic purposes. As a trial for this development, Mulliken add some modifications. He uses exaggerated high rotation incision and it lengthens into midcolumella without backcut. Also he dosen't steal from alar base or lateral lip for vertical height. C-flap is used to lengthen the affected columella and upper lip. The isolated orbicularis oris muscle is coaptated each other for more functional result. With supraperichondral dissection of alar cartilage and transpositioning of caudal septum, he performs synchronous repair of cleft lips, nose and sometimes alveolus. It is still debated when is most suitable age for surgical correction of nasal deformity of cleft lip patients. Done at the time of primary lip repair, there are both some apprehension and inducement. The former are based on technical difficulties due to shortage and fragility of neonatal tissue and possibility of progressive deformities with growing because of iatrogenic injuries to the alar cartilages. But te latter is rationalized because early reposition of deformed nasal cartilage in proper position would induce more natural growth of nasal structures. Some long-term follow up reports reveal the early operation innocent of any growth deterioration. Mulliken treats his cleft lip patient for separated lip and nasal deformities with single operation, and does gingiovoperiosteal alveoloplasty at the same time if necessary. He uses Latham appliance from 4 to 6 week after birth in case of severly collapsed lateral alveolar segment or wide alvolar gap, and perform the definitive opertation at the age of 4 to 6 months. I use lip adhension method to correct more than 10 mm alveolar gap without severe collapse of lateral alveolar segment, but if lateral segment was severely collapsed and away from alvolar arch, I apply the Latham appliance somewhat modificate from original type, which has a metal ring fastened at the front limb of appliance for rubber banding to coaptate easily. I have experienced repair of cleft lip by Mulliken's concept with some modification of my own to 44 cases of unilateral cleft lip patients and conclude that it was very flexible method. Doing with synchonous repair of cleft lip nose, we could get harmonious lip and nose with symmetric nostril sill, cupid's bow and red line. Columella was lengthened primarily. Normal growth of nose was anticipated by anatomic repositioning of alar septal cartilage.
Alveoloplasty ; Cartilage ; Cleft Lip* ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Lip ; Nasal Cartilages ; Nose ; Parturition ; Rubber

Photodynamic therapy(PDT) is a treatment modality by highly reactive oxygen intermediates generated through the interaction of light with a photosensiziter. It has been shown to be an effective treatment for various cutaneous and noncutaneous malignancies. It is efficient for the curative and palliative treatment of epithelial skin tumor in situ or early invasive lesions. In effect, it is a useful alternative treatment for the lesions located on anatomically difficult areas or the large-sized lesions. We treated a case of Bowen's disease arising on the plantar area and 3rd and 4th toewebs of left forefoot in a 61-year-old man with PDT using the hematoporphyrin derivative, porfirmer sodium(Photofrin, Russia) as a photosensitizer and gold vapor laser as a visible light source. The outcome showed partial clinical improvement after about 2 months' follow-up.
Bowen's Disease* ; Follow-Up Studies ; Hematoporphyrin Derivative ; Humans ; Lasers, Gas ; Light ; Middle Aged ; Oxygen ; Palliative Care ; Photochemotherapy* ; Skin

No abstract available.
Hematoma, Subdural, Acute*

We analyzed the composition of urinary stones using chemical analysis method. From 1985 to 1995, 495 urinary calculi were eligible for stone analysis. Forty six per cent of the stones were composed of single chemical component, and pure calcium oxalate stone was the most common type of the stones consisting 34.9% of all stones, followed by 23.8% of mixture of calcium oxalate and calcium phosphate, and 92.7% of the stones had calcium component. Calcium oxalate crystal was found in 82.6% of the stones, calcium phosphate in 50.5%, ammonium magnesium phosphate in 26.7%, uric acid in 11.3% and cystine in 0.4%. Nation-wide extension of this study using chemical analysis will be mandatory for a proper assessment of the stone composition of Koreans and for planning of the proper management strategies for urinary stones in Korea.
Ammonium Compounds ; Calcium ; Calcium Oxalate ; Cystine ; Korea ; Magnesium ; Uric Acid ; Urinary Calculi*

We performed this study to analyse the morbidity and mortality of stoma formation in infants and children over a 17-year period. Thirty-seven stoma formations were performed in 37 patients: 21 for anorectal malformation, 9 for Hirschsprung's disease, 3 for necrotizing enterocolitis, 2 for multiple ileal atresia, 1 for volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation. There were 26 boys and 11 girls with a mean age of 0.4 years. Complications after stoma formation were encountered in 12 patients(32.4%) and included stomal prolapse, stenosis, retraction, dysfunction, skin excoriation and parastomal hernia. Four patients(10.8%) required stomal revision. The incidence of complications was neither related to the age nor to the primary indication for the stoma formation, but sigmoid colostomy was associated with a lower complication rate compared to transverse colostomy(22.1% versus 42.1%, P<0.05). Five patients died, but only one(2.7%) was dead, which was directly related to stoma formation. Eighteen of these children subsequently underwent stoma closure which was associated with complications in six patients(33.3%). The most common complication after stoma closure was wound sepsis in 4 children. In conclusion, because the significant morbidity of stoma formation still exists the refinements in surgical technique may help in reducing the incidence of complications and a sigmoid loop colostomy should be used whenever possible.
Child* ; Colon ; Colon, Sigmoid ; Colostomy ; Constriction, Pathologic ; Enterocolitis, Necrotizing ; Female ; Hernia ; Hernia, Diaphragmatic ; Hirschsprung Disease ; Humans ; Incidence ; Infant* ; Intestinal Volvulus ; Mortality ; Prolapse ; Sepsis ; Skin ; Wounds and Injuries

Double elevator paralysis is a syndrome in which the superior rectus and the inferior oblique muscle of the same eye are paralyzed. The authors have experienced a case of double elevator paralysis with 35 prism diopters hypotropia and 20 prism diopters exotropia on the right eye. The patient was 19 years old female who visited our hospital because of poor cosmetic appearance. Knapp procedure was performed primarily to correct hypotropia, but 20 prism diopters hypotropia remained. 5 months later, a second operation was performed consisted of 7.5 mm recession of the left lateral rectus and 5mm recession of the right inferior rectus in order to correct the exotropia and residual hypotropia. After the second operation, ocular position in primary position was nearly orthophoric and upward movement of the right eye was considerably improved.
Elevators and Escalators* ; Exotropia ; Female ; Humans ; Paralysis* ; Young Adult