Together, the cheek and neck can be considered as a single anatomic location because skin vascularity, texture and thickness are similar. The cervicofacial flap has been described as the treatment of choice for the cheek defect because of its good mobility and excellent cosmetic result. However, if the defects on the cheek are wider than the length of palpebral fissure of extended to the lower two thirds of the cheek, the conventional cervicofacial flaps would be inadequate in size without the benefit of expansion. Tissue expansion of the cheek and neck is distinguished by a particuarly high rate of complication. Prevention of various complications require careful planning and certain modifications in technique. We have used the following modifications and measures to prevent the complications and to maximize the expansion. 1) Whenever possible, expanders were placed over the rigid foundation such as mandible or posterior neck area after wide undermining. 2) Expanders were placed deep to platysma in the neck area. 3) Following optimal expansion, the further dissection extending to the clavicle and the posterior neck area was performed for optimal mobilization and draping of the expanded skin. 4) The expanded skin was advanced upward on the cervical portion and rotated forward on the cheek portion. 5) The flap should not be draped above the inferior orbital rim and postoperatively the pressure garments were applied to prevent drooping of the expanded skin. We experienced 21 cases of the expanded cervicofacial flaps with above surgical modifications and the expanded cervicofacial flaps can resurface the 95% of cheek defects with minimal complications and excellent cosmetic results.
Cheek* ; Clavicle ; Mandible ; Neck ; Orbit ; Skin ; Tissue Expansion

Fatal air embolism can occur during a variety of surgical procedures. We experienced a case of cardiac arrest due to venous air embolism during spinal fusion. A 63-year-old woman underwent spinal fusion for compression fracture on L1 and scolio-kyphosis. Anesthetic induction and initial intraoperative course were completely uneventful until precipitous blood pressure drop occurred, and accompanied by a significant decrease in heart rate and cardiac arrest after use of bone cement. Although more common intraoperative events were presumed and treatment initiated, venous air embolism was considered the etiology of these events when whirring noise was detected by esophageal sthetoscope and a transient decrease in end-tidal carbon dioxide tension was noted by capnometer. We performed cardiac resuscitation with external cardiac compression, various cardiotonic drugs, and removal of air through the right internal jugular venous catheter, but the result was unsuccessful.
Blood Pressure ; Carbon Dioxide ; Cardiotonic Agents ; Catheters ; Embolism, Air* ; Female ; Fractures, Compression ; Heart Arrest ; Heart Rate ; Humans ; Middle Aged ; Noise ; Resuscitation ; Spinal Fusion*

BACKGROUND: The purpose of this study was to find out the effect of hypnotics and analgesics on oxygen saturation by pulse oximetry in surgery patients under spinal anesthesia. METHODS: Sixty-five patients classified ASA physical status 1 or 2 scheduled for surgery under spinal anesthesia were studied. These patients were divided into three groups. The 22 subjects of the first group did not receive either midazolam or fentanyl. The 22 subjects of the second group received midazolam. The 21 subjects of the third group received midazolam (0.03 mg/kg) and fentanyl (1.0 microgram/ kg). Oxygen saturation was measured with a pulse oximetry. Measurements were made before spinal anesthesia, 5 minutes, and 10 minutes after starting of spinal anesthesia, 5 minutes, 10 minutes, 30 minutes, and 60 minutes after the start of the operation or intravenous injection of drugs. In addition, measurements were made on arrival in the recovery room, and 5 minutes, 10 minutes, 20 minutes, and 30 minutes after arrival in the recovery room. RESULTS: There were statistically significant differences in oxygen saturation at 5 minutes after the start of the operation or intravenous injection of drugs. The mean oxygen saturation for the first group was 98.2 +/- 1.8%, for the second group 97.9 +/- 2.6%, and for the third group 92.4 +/- 2.8%. Hypoxia cases at 5 minutes after the start of the operation or intravenous injection of a drug occurred in 4.5% of the first group, 9.1% of the second group, and 57.1% of the third group CONCLUSIONS: We concluded that oxygen saturation monitoring should be done routinely in patients receiving hypnotics and analgesics during spinal anesthesia, and oxygen should be administered to patients who develope hypoxia during spinal anesthesia.
Analgesics* ; Anesthesia, Spinal* ; Anoxia* ; Fentanyl ; Humans ; Hypnotics and Sedatives* ; Incidence* ; Injections, Intravenous ; Midazolam ; Oximetry ; Oxygen ; Recovery Room

PURPOSE: Non-cement total hip arthroplasty for unstable intertrochanteric fracture in elderly patients is regarded as another surgical technique preventing complications such as non-union, long term limitation of weight bearing, pressure sore, pulmonary thromboembolism after open reduction or closed reduction with intramedullary nailing, or plate fixation. We would like to announce the short-term results of primary non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring for unstable intertrochanteric fracture in elderly patients. MATERIALS AND METHODS: All of the 20 patients admitted to the hospital between April 2010 and February 2012 who underwent non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring for unstable intertrochanteric fractures were evaluated. The mean age was 71.1(57-86), there were nine males, and 11 females, with an average follow up period of six months. The post-operative state was evaluated by Harris hip score. RESULTS: The mean operation time was 95 min, and the average blood loss was 800 cc. Mean Harris hip score at the last available follow-up was 92.7, and, among the patients, 15 had all functions of daily life without limitation of walking distance, one had hip dislocation, one had breakage of strands. Pressure sore, deep vein thrombosis, and pulmonary thromboembolism were absent. Radiography at the last available follow-up showed no loosening of the femoral stem in any of the patients, and 13 patients had osteogenesis around the fracture site, and there was no osteolysis. CONCLUSION: Primary non-cement total hip arthroplasty with double strands and double loops figure of 8 wiring in elderly patients with unstable intertrochanteric fractures showed satisfactory results. These results are expected to be useful for further studies with a long-term follow-up and in development of a reduction method.
Aged ; Arthroplasty ; Female ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Hip ; Hip Dislocation ; Hip Fractures ; Humans ; Male ; Osteogenesis ; Pressure Ulcer ; Pulmonary Embolism ; Venous Thrombosis ; Walking ; Weight-Bearing

BACKGROUND: Pulmonary vessels constrict when they are exposed to hypoxia, unlike other vessels. It is hypothesized that the decreased concentration of cAMP in the hypoxic condition causes this reaction, HPV (hypoxic pulmonary vasoconstriction). When cAMP concentration is increased by either activating adenylate cyclase, using adenosine, or inhibiting the cAMP hydrolysing enzyme, phosphodiesterase type 3, using amrinone, then HPV can be reversed. The aims of this study were to develop HPV in an isolated perfused rat lung preparation, and to investigate the vasodilating effects of adenosine and amrinone on HPV. METHODS: Isolated lungs from male rats (270 330 g) were ventilated with a normoxic gas mixture (21%O2-5%CO2-74%N2) or a hypoxic gas mixture (3%O2-5%CO2-92%N2) alternately, and perfused with calcium-containing perfusate solution. Adenosine (6 x 100-2 microgram, n = 6) and amrinone (5 x 101-3 microgram, n = 6) were mixed to perfusate solution, and the initial hypoxic pressor response { Pin = Pmax (maximum pulmonary artery pressure) - Pin (initial pulmonary artery pressure)} and hypoxic pressor responses after drug administration { Pdrug = Pmax (maximum pulmonary artery pressure) - Pbase (baseline pulmonary artery pressure)} were measured. Meclofenamate was used to block prostaglandin-mediated vasorelaxation. RESULTS: Adenosine did not decrease Pdrug compared to Pin. But amrinone inhibited HPV effectively a with a linear dose-response relationship (r = 0.842, P< 0.05). y = 26.72 x log (x) 35.79y: % relaxation = 100 [ Pdrug/ Pin] 100 , x: amount of drug, microgram, CONCLUSIONS: Amrinone attenuated HPV, and it can be concluded that increased levels of cAMP helpful to relax pulmonary vessels in hypoxic condition.
Adenosine ; Adenylyl Cyclases ; Amrinone ; Animals ; Anoxia ; Humans ; Lung* ; Male ; Meclofenamic Acid ; Pulmonary Artery ; Rats* ; Relaxation ; Vasoconstriction* ; Vasodilation

BACKGROUND: Several Studies from western institutes were done on the clinical characteristics and long-term prognosis of patients with variant angina. In these reports, 61-92% of patients had significant coronary artery disease, and survival without myocardial infarction at 1 year was approximately 70-83%. These results differ from our clinical experiences with Korean patients with variant angina;however, no detailed study has been reported in Korea. The purpose of this study was to describe the clinical characteristics and long-term follow-up data of our Korean patients with variant angina. METHODS: Two hundred four consecutive patients with variant angina(M/F;166/38, mean age 53+/-10 year) were included. The diagnosis of variant angina was made by spontaneous spasm in 53, positive intravenous ergonovine(iv Erg) provocation in 52, intracoronary acetylcholine(ic Ach) provocation in 55, simultaneous iv Erg and ic Ach provocation in 48 and bedside intravenous ergonovine with 2-dimensional echocardiography in 33. The clinical and angiographic characteristics were examined in 204 patients and mean 1.5 year(6 month to 3.5 year) follow-up could be done in 165 for the evaluation of long-trem prognosis. RESULTS: The Korean patients with variant angina were characterized by relatively low prevalences of significant coronary stenosis(25%), myocardial infarction and rate of cardiac death. Futhermore, survival and survival without myocardial infarction for the entire group were significantly better in our observation(1 year survival without myocardial infarction, 98%) than in other studies. During the follow-up period, 4(2%) out of 165 patients died, 1 developed myocarddial infarction and ventricular fibrillation occurred in 2. Three of 4 death caused by stopping medication abruptly. Thirteen patients were angina free after discontinued medications during the follow-up. CONCLUSION: The overall prognosis of variant angina may be better in Korean patients. We believe that less severe coronary atherosclerotic disease and a high rate of treatment with calcium blockers may have contributed to the lower rate of cardiac death and myocardial infarction on our patients compared with those in previous studies.
Academies and Institutes ; Calcium ; Coronary Artery Disease ; Death ; Diagnosis ; Echocardiography ; Ergonovine ; Follow-Up Studies* ; Humans ; Infarction ; Korea ; Myocardial Infarction ; Prevalence ; Prognosis ; Spasm ; Ventricular Fibrillation

BACKGROUND: In patients with mitral stenosis(MS) the predilection of the left atrial appendage(LAA) for thrombus formation has been known, while the characteristics and clinical implications of LAA flow have not been clearly analyzed. This prospective study with transesophageal echocardiography(TEE) was done to compare the LAA flow velocities of normal controls and patients with tight MS, to evaluate the correlation between LAA flow and hemodynamic indices and to observe the effects of successful percutaneous mitral valvuloplasty(PMV) on LAA flow. METHODS: TEE was performed in 12 normal controls and 50 patients with tight MS using a 5.0 MHz biplane transducer(Hewlett Packard SONOS 1000). Left atrial spontaneous echo contrast(SEC) was semiquantified(Grade 0-III) according to the relative extent of swirling echo movement in left atrial cavity : Grade I denotes SEC confined to LAA and swirling movement over the half of left atrial cavity was graded as III. In patients with MS. TEE was performed one day before and after PMV.Hemodynamic data(left atrial pressure, transmitral diastolic pressure gradient, cardiac output and mitral valve area) were obtained just before and after PMV. RESULTS: 1) In normal controls LAA flow recording showed two pairs of LAA ejection(positive) and filling(negative) waves. One pair of LAA ejection(appendage peak positive flow ; APF) and filling flow(appendage peak negative flow ; ANF) occurred 143+/-22msec and 289+/-33msec respectively after the onset of the ECG P wave. In early diastole another small pair of LAA ejection(ACF) and filling(ADF) occurred 550+/-21msec and 671+/-50msec respectively after the onset of ECG QRS wave. Mean absolute velocities of APF and ANF were 54+/-21 and 54+/-22cm/sec respectively, which were significantly higher than those of ACF(16+/-6cm/sec) and ADF(16+/-5cm/sec). 2) In patients with tight MS(mitral valve area of 0.9+/-0.3cm2) mean velocities of APF(20+/-12cm/sec) and ANF(23+/-16cm/sec) were significangly decreased compared with normal controls. There was no significant correlation between hemodynamic indices and absolute velocities of LAA flow. SEC was observed in 62%(31/50) and mean velocities of APF(10+/-8cm/sec) and ANF(12+/-11cm/sec) were significantly lower in patients with SEC than those values(25+/-19, 27+/-21cm/sec) in patients without SEC. There was strong negative correlation between the absolute values of APF and ANF and the grade of SEC(rAPF=-0.75, pAPF=0.00 ; rANF=-0.70, pANF=0.00). 3) After successful PMV(mitral valve area of 2.0+/-0.4cm2), APF increased from 20+/-12cm/sec to 36+/-24cm/sec and statistically significant increase of ANF was also observed(23+/-16cm/sec vs 36+/-22cm/sec, p<0.05). In patients with sinus rhythm, PMV normalized LAA flow(APF=52+/-14cm/sec, ANF=51+/-10cm/sec) while still decreased flow velocities were recorded in patients with atrial fibrillation(APF=15+/-4cm/sec, ANF=16+/-6cm/sec). CONCLUSIONS: Recording of LAA flow with TEE is an indicator of LAA function and risk of thrombus formation and cardiogenic embolism, which may not be obtained with conventional hemodynamic indices. Improvement of LAA flow and normalization of flow velocities in patients with sinus rhythm immediately after successful PMV raises a question of role of PMV in prevention of thromboembolism. Randomized sudies of the long-term effects of PMV in MS will be required before this important question can be answered.
Atrial Appendage* ; Atrial Natriuretic Factor ; Atrial Pressure ; Balloon Valvuloplasty* ; Blood Pressure ; Cardiac Output ; Diastole ; Echocardiography, Transesophageal ; Electrocardiography ; Embolism ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Prospective Studies ; Thromboembolism ; Thrombosis

No abstract available.
Humans

BACKGROUND: A clinical trial was done to evaluate the antihypertensive efficacy and side effects of amlodipine, a new long-acting calcium antagonist, in patients with mild to moderate essential hypertension. METHODS AND RESULTS: 1) The study patients consisted of 18 men and 12 women, and the mean age was 49 years. Amlodipine monotherapy (5-10mg) was continued for 12 weeks. 2) Blood pressure dropped significantly in 4 weeks and in 8 weeks, and well maintained throughout the study period. The mean-pressure drop was 32.9/20.8mmHg after 12 weeks. 3) Heart rate did not change significantly with amlodipine therapy. 4) Optimal dose for effective pressure-drop was 10mg in 57% of patients. Overall good antihypertensive effect was achieved in 83% of patients. 5) All of the laboratory parameters including blood chemistry, glucose, lipid and electrolytes did not change significantly after 12 weeks. 6) Side effects were mild in nature(gastrointestinal discomfort in 3, dry mouth in 1, weakness in 1, dizziness in 1 and headache in 1 patient). CONCLUSION: Amlodipine monotherapy with 5 to 10mg once a day regimen is effective and well tolerated in the patients with mild to moderate essential hypertension.
Amlodipine ; Blood Pressure ; Calcium ; Chemistry ; Dizziness ; Electrolytes ; Female ; Glucose ; Headache ; Heart Rate ; Humans ; Hypertension* ; Male ; Mouth

BACKGROUND: Follow-up angiographic study was performed in patients who underwent successful coronary artery stenting(Palmaz-Schatz) to native coronary arteries, to evaluate the restenosis rate and angiographic features. METHOD: Follow-up angiography was done in 6 months after coronary arteries stenting in 16 of 22 patients(follow-up rate : 73%) regardless of symptom recurrence or the result of exercise treadmill test. RESULTS: 1) Total 26 Palmaz-Schatz stents were implanted in 26 patients with coronary stenosis : primary, elective stenting in 19, bail-out procedure in 4 and restenosis after prior coronary angioplasty(PTCA) in 4 patients. The morphological characteristic of the leisons were type A in 1, type B in 20 and type C in 5. 2) Coronary stenting was successful in all patients and no significant procedure-related cardiac event occurred. Subacute closure in the stent and bleeding complication developed in minority of patients. 3) The overall restenosis rate in six months was 31%. 4) The diameter stenosis of the lesion in the patients without restenosis was 94% before stenting, 6% immediately after stenting and 26% in 6 months. CONCLUSION: Coronary artery stenting is a safe and useful interventional procedure which can be done with low risk even in the complicated leison. The restenosis rate is comparable to conventional PTCA. The long-term outcome of coronary stenting might be more favorable and promising with more selective and strict application of this procedure.
Angiography* ; Constriction, Pathologic ; Coronary Stenosis ; Coronary Vessels* ; Exercise Test ; Follow-Up Studies* ; Hemorrhage ; Humans ; Recurrence ; Stents