No abstract available.
Arthritis* ; Arthroplasty* ; Arthroplasty, Replacement, Knee*

Spontaneous perforation of bile duct in adults is very rare, with less than 30 cases described in the literature to date. We repoit a case of a 65-year-old man who presented with severe colicky abdominal pain and fever, just like symptoms of peritonitis. ERCP provided a preoperative noninvasive confirmation of the diagnosis of the rupture of right intrahepatic duct. The patient was performed T-tube choledochotomy and drainage of retroperitoneal bile collection. The etiolgy, diagnosis, and treatment of spontaneous perforation of bile duct is discussed.
Abdominal Pain ; Adult ; Aged ; Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis* ; Drainage ; Fever ; Humans ; Peritonitis ; Rupture

Application of local flaps for releasing postburn scar contracture has been limited because of a problem of invisible loss, difficulty to obtain the satisfactory result against correction of limitation of motion and possibility of contour deformity. However, proper use of local flaps, accurate designs and complete wound compression for a long term after operation enable to obtain good results in correction of some cases of postburn scar contracture. It will be related to reduce unsightly scaring when contractures are released. For this purpose, we have used a modified planimetric Z-plasty, a subcutaneous pedicle flap, a new classification V-Y plasties which was proposed based on the new concept and their combination. Proper application of local flaps corresponding to the degree of contracture and shape of burn scar have enabled to increase the use of local flaps against correction of postburn scar contracture during our past 15 years, from 1982 to 1997, we treated 235 cases of postburn scar or scar contracture in various regions except for the face. Of these, 177 cases were applicated with local flaps and we could have a good results in both aspects of function and appearance. We report our operative methods, a criterion to application of local flaps and representative results.
Burns ; Cicatrix* ; Classification ; Congenital Abnormalities ; Contracture* ; Wounds and Injuries

A free radical gas, nitric oxide NO), has many useful functions when produced under physiological conditions by neurons and endothelial cells. However, excess NO has been reported to exert cytotoxic effects by direct toxicity or by reaction with superoxide. Nitric oxide can react with superoxide to generate peroxynitrite which is as reactive as the hydroxyl radical. This study was attempted to observe formation of peroxynitrite and change in amount of NO synthase(NOS) in reperfused skin flap of rats following ischemia. 3-nitro-L-tyrosine, as direct evidence of peroxynitritemediated tissue damage, as well as endothelial and inducible NO synthase(eNOS and iNOS) were studied in ischemic and reperfused skin using western blot analysis. In addition, HNE-modified proteins, as direct evidence of oxidative tissue damage by reactive oxygen species(ROS), was also evaluated. Skin specimens were obtained over time from island skin flaps(3x3 cm2) of rats under the following two conditions: 1) reperfusion following 5 hours of ischemia, and 2) reperfusion following 10 hours of ischemia. In reperfused skin after 5 hours of ischemia, formation of 3-nitro-L-tyrosine and HNE-modified proteins was decreased 1 hour after reperfusion. However, they were thereafter increased and reached a maximum (3-nitro-L-tyrosine: 142%,HNE-modified proteins:237%) 6 hours after reperfusion. In reperfused skin after 10 hours of ischemia, formation of 3-nitro-L-tyrosine and HNE-modified proteins was increased 3 hours post reperfusion, and reached a maximum (3-nitro-L-tyrosine:178%, HNE-modified proteins: 204%) 6 hours after reperfusion. eNOS and iNOS were decreased 1,3 and 6 hours reperfusion following both 5 and 10 hours of ischemia. These results indicate that peroxynitrite-mediated cytotoxicity is involved in ischemic reperfused skin despite the fact that the amounts of both iNOS and eNOS are decreased.
Animals ; Blotting, Western ; Endothelial Cells ; Hydroxyl Radical ; Ischemia ; Neurons ; Nitric Oxide* ; Oxygen ; Peroxynitrous Acid ; Rats* ; Reperfusion ; Skin* ; Superoxides

Synthetic genes encoding the gag p24 and the part of the envelope protein gp41 of the human immunodeficiency virus (HIV-1) were cloned and overexpressed as fusion proteins in Escherichia coli, using an expression vector carrying 77 promoter and the poly-histidine leader sequence. The overexpressed p24 fusion protein was purified by centrifugation, Ni-affinity chromatography and CM-sepharose chromatography The overexpressed gp41 fusion protein was purified by centrifugation, C4 chromatography and DEAE-sepharose chromatography. The purified fusion proteins showed a high level of purity and immunoreactivity in SDS-polyacrylamide gel electrophoresis and western blot analysis. These results suggest that this prokaryotic expression-purification method is suitable for obtaining a large amount of the viral antigen which may be useful for screening of antibodies to HIV-1 in human blood samples.
Antibodies ; Blotting, Western ; Centrifugation ; Chromatography ; Clone Cells ; Electrophoresis ; Escherichia coli ; Genes, Synthetic ; HIV* ; HIV-1* ; Humans* ; Mass Screening

Cavernous hemangioma is the most common primary tumor occurred in adults' orbit. This tumor has symptoms characteristically developing over several years with slowly progressive proptosis, eyeball deviation, hyperopia, diplopia and optic nerve compression. It's removal, necessary when there is progressive exophthalmos and visual deficit, is best performed en bloc to avoid intraoperative vleeding, the risk of residue, and potential further growth. In principle, surgical approach to the orbit must provide maximum safety and optimal visualization. The noncompressibility of the globe imposes greater demand on the need for some removal of the osseous orbit for surgical approach. This also must permit immediate functional and aesthetic reconstruction. The authors have experienced a case of large cavernous hemangioma in the orbit inferomedially. The surgical treatment of tumor was achieved by inferomedial approach combined with inferolateral orbitotomy. This surgical approach allows better visualization of the tumor and greater protection of essential anatomic structures. This also permits immediate functional and aesthetic reconstruction. So we present our case with a brief review of the literature related to orbital cavernous hemangioma.
Diplopia ; Exophthalmos ; Hemangioma, Cavernous* ; Hyperopia ; Optic Nerve ; Orbit*

So called pseudosarcoma of the esophagus is an extremely rare polypoid malignant tumor and a number of cases, totaling 19 cases have been reported in world literatures until 1985. The presenting case is an unique one of pseudosarcoma of the esophagus and we illustrated all microscopic features with mapping, immunoperoxidase stain for cytokeratin and electron microscopic findings to clarify the histogenesis of spindle cells. It is postulated that the spindle cells of pseudosarcoma are transformed from squamous carcinoma cells based on (1) morphological similarity between squamous epithelial cells and spindle cells, (2) positive reaction of immunoperoxidase staining for cytokeratin in the adjacent normal esophageal mucosa, squamous cell carcinoma, spindle cells and giant cells and (3) presence of transformation zone.

Many plastic surgeons have been tried to attain ultimate goal lies in restoring the original shape and function of the facial aesthetics, in reconstruction of deformities resulting from facial hypertrophic scar and skin defects. This would require consideration in terms of hanmony in color match, skin texture and thickness. Various forms of skin graft, local flap, distant flaps, free flap and tissue expander have been employed in restoring skin defects and deformities of the cheek and submental area, and the use of large local flaps utilizing the cervicofacial skin flaps or tissue expander have brought about improved aesthetic results. the authers have obtained satisfactory results in treating 2 cases of wide hypertrophic scar of the cheek and submental area with combination of wide cervical flap and intraoperative tissue expansion using foley catheter. the merits of this combined operative methods are as follows : 1. It is not necessory to keep tissue expander for a long period. 2. This technique is able to diminish the cost of multistage operation and using of tissue expander. 3. There is no psychologic problems due to undesirable facial appearance during tissue expansion period. 4. Rapid intraoperative tissue expansion by foley catheter during elevating wide cervical flap can allow to dissect one, preserving the perforators without bleeding in a short time. 5. Wide cervical flap and additional expanded tissue by means of intraoperative tissue expansion could brought into suturing avoiding tension of oral commissure and lip eversion. 6. Preservation of perforators of cervical flap above the platysma muscle raised flap's survival rate and then this result could prevent distal ischemic necrosis after flap coverage.
Catheters ; Cheek ; Cicatrix, Hypertrophic* ; Congenital Abnormalities ; Esthetics ; Free Tissue Flaps ; Hemorrhage ; Lip ; Necrosis ; Skin ; Survival Rate ; Tissue Expansion Devices ; Tissue Expansion* ; Transplants

No abstract available.

Remnant thyroglossal ducts are common developmental abnormalities of the thyroid gland. The malignant transformation of these structures is extremely rare. Even though a malignancy it is highly suspected in elderly patients with midline neck swelling, the diagnosis is seldom made preoperatively. In thyroglossal duct carcinomas, a papillary carcinoma is the most common pathologic finding. The etiology of such tumors is unclear, but a de novo origin and spread from primary thyroid-gland tumors has been suggested. There are different theories regarding the origin of and the therapy for these malignancies. This has important significance for therapeutic approaches. We report a case of a papillary cancer arising in a remnant thyroglossal duct which was managed by Sistrunk's operation and right thyroid lobectomy.
Aged ; Carcinoma, Papillary ; Diagnosis ; Humans ; Neck ; Thyroid Gland