In the practice of modern craniomaxillofacial surgery, there is a general agreement in favor of obtaining solid bony union through the use of titanium and vitallium rigid fixation. These metallic osteosynthesis are not free from inherent drawbacks and limitation. They are liable to have an adverse effect on the growth of the craniofacial skeleton, be a cause of secondary bony resorption, increase risk of infection, result in palpability or exposure and cause artifact in radiologic imaging. These can lead to undue secondary operations necessitating their removal. To overcome there shortcomings, there had been a continuous research on the development of a bioabsorbable skeletal fixation system using polymer of polylactic and polyglycolic acid. Recently, with introduction and commercial availability of a product(Lactosorb, Walter Lorenz) with a minimized resorption period and foreign body reaction, there is an increasing acceptance of its use as an alternative fixation device in craniomaxillofacial surgery. In effort to extend its use in facial bone fractures, Tatum and Eppley were the first report in its successful application in a clinical setting. We report on the clinical experience of such bioabsorbable rigid fixation in patients with maxillofacial trauma. In included one adult and three children in their growth period, underwent open reduction of facial bone fractures. They were followed up in terms of clinical and radiologic outcome for six months. Stalbe and adequate longterm fixation was obtained and no recurrences were noted.
Adult ; Artifacts ; Child ; Facial Bones* ; Foreign-Body Reaction ; Fracture Fixation* ; Humans ; Polyglycolic Acid ; Polymers ; Recurrence ; Skeleton ; Titanium ; Vitallium

BACKGROUND: Intracellular ionized calcium plays a central role in the transduction of external stimuli as a critical second messenger. The spectral properties of fluo-3 allows the analysis of intracellular ionized calcium level by flow cytometers. The aim of this study is to assess the performance of flow cytometer for measuring intracellular ionized calcium level using fluo-3 and to define the reference interval of intracellular ionized calcium level of lymphocytes from healthy people, and to find out the clinical implications according to various disorders. METHODS: For the analytical performance of flow cytometer on determining the concentration of intracellular ionized calcium, precision study, lowest limit of detection, analytical range, and the loading stability of fluo-3 were per foamed. Fifty-four cases of healthy people, 52 cases of renal transplant patients, and 20 cases of diabetes mellitus patients were included in this study. RESULTS: Loading effect of fluo-3 at room temperature was stable upto 5 hours. Lowest limit of detection of ionized calcium concentration was 4.34 nM at in-situ calibration procedure. Within-run and among-day intraindividual CVs of in-situ calibration procedure were 6.67% and 13.99% respectively, and of optical calibration procedure were 13.86% and 16.12% respectively. The reference interval of cytosolic free calcium level for healthy people ranged 73.54 - 155.09 nM without sexual differences. The level of intracellular ionized calcium was lowered by 36.9% on renal transplant group in comparison with healthy control group. But, level of cytosolic free calcium was Increased upto 276.0% on acute rejection group and 159.1% on diabetes mellitus group compared to control group. CONCLUSIONS: These results reveal that in-situ calibration method for intra cellular ionized calcium using flow cytometry with flue-3 can be regarded as an accurate and standardized method. Quantitation of intracellular ionized calcium level might be used as the monitoring test for early detection of acute rejection after renal transplantation.
Calcium* ; Calibration ; Cytosol ; Diabetes Mellitus ; Flow Cytometry* ; Humans* ; Kidney Transplantation ; Limit of Detection ; Lymphocytes* ; Second Messenger Systems

There was a report that midazolam-thiopental coinduction reduced ED99 of thiopental for hypnosis from 5.75 mg to 2.37 mg. This study was designed to test whether the former study can be used clinically and to compare midazolam-thiopental coinduction with thiopental or midazolam induction. After 120 patients of ASA calss I, II classified into 3 groups randomly, 5.75 mg/kg of thiopental was injected intravenously to each patient for Group I while 0.23 mg/kg of midazolam was injected intravenously to each patient for Group II. For Group III, 2.37 mg/kg of thiopental was injected intravenously to each patient one minute after 0.02 mg/kg of midazolam was injected. Induction rate, induction time, and the changes of cardiovascular response for each group have been compared and the results are as follows: 1) Induction rate was 100%, 75%, 75% for each group. 2) Time for the spontaneous eye closure and loss of the eyelid reflex for Group I were 12.2+/-8.0 seconds, 20.36.9 seconds respectively, while for Group II 51.5+/-26.5 seconds, 69.3+/-29.5 seconds, and for Group III, 25.3+/-7.4 seconds, 37.0+/-10.8 seconds (G. I< G. III < G. II). 3) However, heart rate was relatively higher in Group I at the point of induction but there were no significant differences between groups statistically. 4) It was also impossible to prove that the changes of blood pressure were more stable in one group than others statistically. By judging from the results above, midazolam-pentothal coinduction can be a useful means of induction but coinduction is not superior to thiopental or midazolam induction.
Blood Pressure ; Eyelids ; Heart Rate ; Humans ; Hypnosis ; Midazolam* ; Reflex ; Thiopental*

BACKGROUD: A lot of "Folk Remedies" on rheumatoid arthritis treatment prevail in Korea, but they have never been evaluated or investigated systemically. Therefore we studied folk remedies used in rheumatoid arthritis patients. METHODS: We delivered 12 questionnaires to 106 rheumatoid arthritis out -patients of family medicine, internal medicine, and orthopedics, located in Seoul and Kyungki area. These questionnaires addressed to demographic characteristics, duration of rheumatoid arthritis, current treatments, kind of folk remedies experienced, decision to choose folk remedies and its subjective effects, and volition to try new folk remedies. RESULTS: There were up to 27 kinds of folk remedies used by 77 people (72.8% of total). Lower education level was proved to be correlated with folk remedies experience. Most patients began their remedies introduced by relatives or close friends (83.1%) . Many Patients on folk remedies were skeptical about its effect, but they were still willing to try new folk medicine (80.6%). Many rheumatoid arthritis patients experienced folk remedies and were skeptical about its effects, but they were still willing to try new folk medicine. Therefore, education on folk remedies is needed.
Arthritis, Rheumatoid* ; Education ; Friends ; Humans ; Internal Medicine ; Korea ; Medicine, Traditional* ; Orthopedics ; Seoul ; Volition ; Surveys and Questionnaires

The reconstruction of defects after the resection of oropharyngeal tumors must not only cover the defect area but also be able to recover its functional structure enabling speech and mastication. To achieve a functional reconstruction, the volume and the length of the pedicle must be suitably designed and a donor site fit for the location and size of the defect must be chosen. However, in reality, the structures in oropharyngeal tumor patients who underwent resection to classify the different defect shapes according to the resection site. Bases on the classification of oropharyngeal defects, we tried to standardize a flap design method for the different defects. We investigated 44 patients who underwent tumor resection and reconstruction surgery for oropharyngeal tumor during the past 3 years at Severance hospital. The defects were divided into 6 zones and 4 types of design methods of radial forearm free flap were standardized. Surgery was performed on 25 patients during September of 1998 to September of 1999 with modified design methods based on the standardized ones. A faster and more efficient flap design was possible due to the standardized method. It was also possible to enable a functional reconstruction in cases where the soft palate was involved without any nasal escape.
Classification ; Forearm* ; Free Tissue Flaps* ; Humans ; Mastication ; Palate, Soft ; Tissue Donors ; Tongue Neoplasms ; United Nations

OBJECTIVES: The purpose of this study was to investigate the effects of methysergide(serotonin receptor antagonist) on serum growth hormone response after electroconvulsive therapy(ECT). METHODS: We studied the changes of the serum growth hormone levels of the day before ECT(No ECT), ECT without methysergide pretreatment(ECT alone), and ECT with methysergide pretreatment(M+ECT) by radioimmunoassay method in 14 psychiatric patients. ECT was induced by the application of 110 volts for a period 0.3-1.0 second, using bitemporal electrodes. RESULTS: 1) Serum growth hormone levels at 15, 30, and 60 minutes after ECT were significantly increased in the ECT alone group than in the No ECT group(p<0.05). 2) Serum growth hormone levels at 15, 30, and 60 minites after ECT were significantly decreased in the M+ECT group than in the ECT alone group(p<0.05). CONCLUSION: These results suggest that the response of growth hormone after ECT seems to be mediated by the activation of serotonergic system.
Electroconvulsive Therapy* ; Electrodes ; Growth Hormone* ; Humans ; Methysergide* ; Radioimmunoassay

BACKGROUND: In breast reconstruction using implants after unilateral mastectomy, it is challenging to create a natural, ptotic contour, and asymmetry is a potential drawback. To achieve breast symmetry and an ideal shape for both breasts, we performed contralateral augmentation in patients undergoing breast reconstruction with implants. METHODS: Patients underwent unilateral mastectomy and 2-stage reconstruction. During the second stage of the procedure, contralateral augmentation mammoplasty was performed. Preoperatively, we obtained the patients’ demographic information, and we then assessed breast volume, the volume and dimensions of the inserted implants, and complications. Breast symmetry was observed by the surgeon and was assessed by measuring the disparity between the final volume of each breast. RESULTS: Contralateral augmentation was performed in 52 cases. When compared to patients who did not undergo a contralateral balancing procedure, patients who received contralateral augmentation were younger, thinner, and had smaller breasts. During implant selection for contralateral augmentation, we chose implants that were approximately 1 cm shorter in width, 1 level lower in height, and 1 or 2 levels lower in projection than the implants used for reconstruction. The postoperative breast contours were symmetric and the final volume discrepancy between each breast, which was measured by 3-dimensional scanning, was acceptable. CONCLUSIONS: We demonstrate that contralateral augmentation can be recommended for patients who perceive their breasts to be small and not beautiful in order to achieve an ideal and beautiful shape for both breasts. Furthermore, this study offers guidelines for selecting the implant that will lead to the optimal aesthetic outcome.
Breast Implants ; Breast* ; Female ; Humans ; Mammaplasty* ; Mastectomy

BACKGROUND: In breast reconstruction using implants after unilateral mastectomy, it is challenging to create a natural, ptotic contour, and asymmetry is a potential drawback. To achieve breast symmetry and an ideal shape for both breasts, we performed contralateral augmentation in patients undergoing breast reconstruction with implants. METHODS: Patients underwent unilateral mastectomy and 2-stage reconstruction. During the second stage of the procedure, contralateral augmentation mammoplasty was performed. Preoperatively, we obtained the patients’ demographic information, and we then assessed breast volume, the volume and dimensions of the inserted implants, and complications. Breast symmetry was observed by the surgeon and was assessed by measuring the disparity between the final volume of each breast. RESULTS: Contralateral augmentation was performed in 52 cases. When compared to patients who did not undergo a contralateral balancing procedure, patients who received contralateral augmentation were younger, thinner, and had smaller breasts. During implant selection for contralateral augmentation, we chose implants that were approximately 1 cm shorter in width, 1 level lower in height, and 1 or 2 levels lower in projection than the implants used for reconstruction. The postoperative breast contours were symmetric and the final volume discrepancy between each breast, which was measured by 3-dimensional scanning, was acceptable. CONCLUSIONS: We demonstrate that contralateral augmentation can be recommended for patients who perceive their breasts to be small and not beautiful in order to achieve an ideal and beautiful shape for both breasts. Furthermore, this study offers guidelines for selecting the implant that will lead to the optimal aesthetic outcome.
Breast Implants ; Breast* ; Female ; Humans ; Mammaplasty* ; Mastectomy

OBJECTIVE: Immediate early gene (IEG), c-fos is known to encode a 62 kDa nuclear protein (Fos) which has a critical role in the stimulus response process of many cells. c-fos can be activated in the central nervous system by a variety of physiological and pharmacological treatment. Recently evidences has been reported suggesting that glucocorticoid hormones, which are released from adrenal cortex in response to stress, may regulate IEG expression. We observed whether immobilization stress or corticosterone altered the induction of c-fos by haloperidol in the nucleus accumbens, lateral striatum, and prefrontal cortex. METHODS: Twenty-four healthy Wistar rats of male sex, weighing 300-450 g, were divided into 6 groups according to injection agents [vehicle (1 mg/kg), haloperidol (1 mg/kg), corticosterone (1 mg/kg), immobilization stress, haloperidol (1 mg/kg) and corticosterone (1 mg/kg), haloperidol (1 mg/kg) and immobilization stress] respectively. Fos-immunoreactivity was measured by counting of Fos-positive neurons in the nucleus accumbens, lateral striatum, and prefrontal cortex. RESULTS: (1) The number of Fos-positive neurons in the nucleus accumbens was significantly decreased in the haloperidol plus immobilization stress group and haloperidol plus corticosterone group compared with that in the haloperidol group (p<0.05). (2) The number of Fos-positive nurons in the lateral striatum was significantly decreased in the haloperidol plus corticosterone group compared with that in the haloperidol group, but the number of Fos-positive neurons in the lateral striatum was not significantly different between the haloperidol plus immobilization stress group and the haloperidol group (p<0.05). (3) The number of Fos-positive neurons in the prefrontal cortex was significantly increased in the haloperidol plus immobilization stress group and haloperidol plus corticosterone group compared with that in the haloperidol group (p<0.05). CONCLUSION: These results suggest that regulatory process exerted by corticosterone may alter the antipsychotic effect of haloperidol.
Adrenal Cortex ; Animals ; Antipsychotic Agents ; Brain* ; Central Nervous System ; Corticosterone* ; Haloperidol ; Humans ; Immobilization* ; Male ; Neurons ; Nuclear Proteins ; Nucleus Accumbens ; Prefrontal Cortex ; Rats* ; Rats, Wistar

BACKGROUND: The extended latissimus dorsi flap is important for breast reconstruction. Unfortunately, donor site seroma is the most common complication of extended latissimus dorsi flap for breast reconstruction. Although using fibrin sealant in the donor site reduces the rate of seroma formation, donor site seroma remains a troublesome complication. The purpose of this study was to analyze the effectiveness of the combination of quilting sutures and fibrin sealant in the latissimus dorsi donor site for the prevention of seroma. METHODS: Forty-six patients who underwent breast reconstruction with extended latissimus flap were enrolled in the study. The patients received either fibrin sealant (group 1, n=25) or a combination of fibrin sealant and quilting sutures (group 2, n=21) in the extended latissimus dorsi donor site. Outcome measures were obtained from the incidence, volume of postoperative seroma, total drainage amount, indwelling period of drainage, and duration of hospital stay. RESULTS: The incidence of seroma was 76% in group 1 and 42.9% in group 2 (P=0.022). We also found significant reductions in seroma volume (P=0.043), total drainage amount (P=0.002), indwelling period of drainage (P=0.01), and frequency of aspiration (P=0.043). The quilting sutures did not affect the rate of drainage, tube reinsertion, or hospital stay. CONCLUSIONS: The use of quilting sutures combined with fibrin sealant on the latissimus dorsi flap donor site is helpful for reducing the overall seroma volume, frequency of aspiration, and total drainage amount.
Drainage ; Female ; Fibrin ; Fibrin Tissue Adhesive ; Humans ; Incidence ; Mammaplasty ; Outcome Assessment (Health Care) ; Seroma ; Surgical Flaps ; Suture Techniques ; Sutures ; Tissue Donors