Mobius syndrome is a rare congenital disease characterized by unilateral or bilateral limitation of abduction and facial palsy due to the 6th and 7th cranial nerve paralysis. In addition, it may be associated with limb anomalies and other cranial nerve paralysis. We experienced three cases of Mobius syndrome characterized by esodeviation associated with bilateral limitation of abduction, bilateral facial atroph, tongue atrophy, congenital amputation of limb, and congenital clubfoot. We performed a large amount of bilateral medial rectus recession and unilateral lateral rectus resection, and obtained cosmetically successful results that orthophoric or less than 10 prism diopter of esotropia in primary postition, but mild limitation of adduction was observed as a complication.
Amputation ; Atrophy ; Clubfoot ; Cranial Nerves ; Esotropia ; Extremities ; Facial Paralysis ; Mobius Syndrome* ; Paralysis ; Tongue

When the split thickness skin graft (STSG) was harvested from the patient's posterior thigh in supine position, an accidental donor site injury could occur by postural instability with the raised leg of patient. The idea of partial return of the harvested graft to the donor site, spraying fibrin sealant and using skin fragments have been individually introduced as the management of donor site injury created during harvest of the STSG. However, in our knowledge, there has been no attempt to combine the three ideas and apply to the accidental STSG donor site injury. We present the fragments regraft technique, with deliberately leaving some of harvested skin, cutting the remnant skin into small pieces, and immediately returning the skin fragments by spraying fibrin sealant on the damaged donor site wound. This method could be considered as a treatment option to prevent delayed wound healing of STSG donor site injury, especially when elderly or debilitated patients who are suspected of a delayed wound healing and poor-quality skin.
Aged ; Fibrin Tissue Adhesive ; Humans ; Leg ; Skin ; Skin Transplantation ; Supine Position ; Thigh ; Tissue Donors* ; Transplant Donor Site ; Transplants ; Wound Healing ; Wounds and Injuries

PURPOSE: An ideal suturing material should be strong, easy to handle, should produce minimal tissue reaction and finally should disappear without a trace. Various micro-vascular suture materials have been produced in the past several decades in order to meet these demands. We have used nylon suturing material in experimental microsurgery because it is less expensive than polypropylene. After carotid artery end-to-end anstomosis, we found fusiform aneurysm incidentally. In this study 9-0 nylon (group I) and 9-0 polypropylene (group II) were compared to 10-0 nylon (group III), and 10-0 polypropylene (group IV) in order to survey the incidence of aneurysmal development in each material for use in microvascular surgery. METHOD: Forty Sprague-Dawley rats, 230 g to 350 g body weight, were used for this study. The carotid arteries were anastomosed end-to-end with 9-0 nylon, and 10-0 nylon, in addition to 9-0 polypropylene, and 10-0 polypropylene. The suture number of all arteries was 10 points except for two cases were 11 points due to uncontrolled bleeding. Specimens were harvested 1 week, 3 weeks, 6weeks and 10 weeks postoperatively. RESULT: The number of animals studied during the first week totaled 20 carotid arteries and they showed no interval change. After 3 weeks, we identified aneurysms in following cases: group I 3 cases, group II 2 cases, group III 1 case and group IV 1 case per five cases in each group. After 6 weeks, gross aneurysmal changes seen: group I, all (5) cases; Group II, 2 cases; group III, all (5) cases; Group IV, 3 cases. After 10 weeks, many aneurysms were observed: group I, all (5) cases; group II, all (5) cases; group III, 0 case; group IV, 2 cases. The aneurysms were measured and ranged in size from 1.3 mm to 8.1 mm. Histological analysis for inflammation, fibrosis and medial necrosis at the anastomosis site revealed no significant difference between same sized suture materials. If the experimental aneurysms were more than 5 times the diameter of the carotid artery, the aneurysms were considered to be experimental giant aneurysms. Seventy of our 34 experimental aneurysms were considered to be giant aneurysms. CONCLUSION: Our findings demonstrate that the development of aneurysms was related to size of the suture material and not the type of suturing material used. An ideal suture material for anastomosisof the carotid artery in the rat wasd a 10-0 monofilament suture material with suture numbers was above 10 points. We also made good aneurysm model. When we used 9-0 suture material and suture numbers were below 10 points multiple aneurysms developed. This model demonstrated the development mechanism of giant fusiform aneurysms.
Aneurysm* ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common* ; Fibrosis ; Hemorrhage ; Incidence ; Inflammation ; Microsurgery ; Necrosis ; Nylons ; Polypropylenes ; Rats* ; Rats, Sprague-Dawley ; Sutures

PURPOSE: An ideal suturing material should be strong, easy to handle, should produce minimal tissue reaction and finally should disappear without a trace. Various micro-vascular suture materials have been produced in the past several decades in order to meet these demands. We have used nylon suturing material in experimental microsurgery because it is less expensive than polypropylene. After carotid artery end-to-end anstomosis, we found fusiform aneurysm incidentally. In this study 9-0 nylon (group I) and 9-0 polypropylene (group II) were compared to 10-0 nylon (group III), and 10-0 polypropylene (group IV) in order to survey the incidence of aneurysmal development in each material for use in microvascular surgery. METHOD: Forty Sprague-Dawley rats, 230 g to 350 g body weight, were used for this study. The carotid arteries were anastomosed end-to-end with 9-0 nylon, and 10-0 nylon, in addition to 9-0 polypropylene, and 10-0 polypropylene. The suture number of all arteries was 10 points except for two cases were 11 points due to uncontrolled bleeding. Specimens were harvested 1 week, 3 weeks, 6weeks and 10 weeks postoperatively. RESULT: The number of animals studied during the first week totaled 20 carotid arteries and they showed no interval change. After 3 weeks, we identified aneurysms in following cases: group I 3 cases, group II 2 cases, group III 1 case and group IV 1 case per five cases in each group. After 6 weeks, gross aneurysmal changes seen: group I, all (5) cases; Group II, 2 cases; group III, all (5) cases; Group IV, 3 cases. After 10 weeks, many aneurysms were observed: group I, all (5) cases; group II, all (5) cases; group III, 0 case; group IV, 2 cases. The aneurysms were measured and ranged in size from 1.3 mm to 8.1 mm. Histological analysis for inflammation, fibrosis and medial necrosis at the anastomosis site revealed no significant difference between same sized suture materials. If the experimental aneurysms were more than 5 times the diameter of the carotid artery, the aneurysms were considered to be experimental giant aneurysms. Seventy of our 34 experimental aneurysms were considered to be giant aneurysms. CONCLUSION: Our findings demonstrate that the development of aneurysms was related to size of the suture material and not the type of suturing material used. An ideal suture material for anastomosisof the carotid artery in the rat wasd a 10-0 monofilament suture material with suture numbers was above 10 points. We also made good aneurysm model. When we used 9-0 suture material and suture numbers were below 10 points multiple aneurysms developed. This model demonstrated the development mechanism of giant fusiform aneurysms.
Aneurysm* ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common* ; Fibrosis ; Hemorrhage ; Incidence ; Inflammation ; Microsurgery ; Necrosis ; Nylons ; Polypropylenes ; Rats* ; Rats, Sprague-Dawley ; Sutures

PURPOSE: The effect of PTK inhibitors (herbimycin A and genistein) on the induction of radiation-induce d apoptosis in Ph-positive K562 leukemia cell line was investigated. MATERIALS AND METHODS: K562 cells in exponential growth phase were irradiated with a linear accelerator at room temperature. For 6 MV X-ray irradiation and drug treatment, cultures were initiated at 2x10' cells/mL. The cells were irradiated with 10 Gy. Stock solutions of herbimycin A and genistein were prepared in dimethyl sulphoxide (DMSO). After incubation at 37C for 0-48 h, the extent of apoptosis was determined using agarose gel electrophoresis and TUNEL assay. The progression of cells throughth the cel l cycle after irradiation and drug treatment was also determined with flow cytometry. Western blot analysis was used to monitor bcl-2, bcl-X and bax protein levels. RESULTS: Treatment with 10 Gy X-irradiation did not result in the induction of apoptosis. The HMA alone (500 nM) also failed to induce apoptosis. By contrast, incubation of K562 cells with HMA after irradiation resulted in a substantial induction of nuclear condensation and fragmentation by agarose gel electro-phoresis and TUNEL assay. Genistein failed to enhance the ability of X-irradiation to induce DN A fragmentation. Enhancement of apoptosis by H MA was not attributable to downregulation of the bcl-2 or bcl-X anti-apoptotic proteins. When the cells were irradiated and maintained with HMA, the percentage cf cells in G2/M phase decreased to 30-40% at 48 h. On the other hand, cells exposed to 10 Gy X-irradiation alone or maintained with genistein did not show marked cell cycle redistribution. CONCLUSION: We have shown that nanomolar concentrations of the PTK inhibitor HMA synergize with X-irradiation in inducing the apoptosis in Ph (+) K562 leukemia cell line. While, genistein, a PTK inhibitor which is not selective for p2 10""'' failed to enhance the radiation induced apoptosis in K562 cells. It is unlikely that the ability of HMA to enhance apoptosis in K562 cells is attributable to bcl-2 family. It is plausible that the relationship between cell cycle delays and cell death is essential for drug development based on molecular targeting designed to modify radiation-induced apoptosis.
Apoptosis Regulatory Proteins ; Apoptosis* ; bcl-2-Associated X Protein ; Blotting, Western ; Cell Cycle ; Cell Death ; Cell Line ; Dimethyl Sulfoxide ; Down-Regulation ; Electrophoresis, Agar Gel ; Flow Cytometry ; Genistein ; Hand ; Humans ; Hydrogen-Ion Concentration ; In Situ Nick-End Labeling ; K562 Cells* ; Leukemia ; Particle Accelerators ; Sepharose

BACKGROUND: Lifestyle is an important risk factor for many diseases. We need to educate medical students for advocating health promoting behaviors to their patients. Teaching knowledge, however, was not enough for medical students to change their health-related lifestyle. In this study, we investigated health promoting behaviors of medical students, and the improvement of their health behaviors after competitive lifestyle modification program. METHODS: All sophomores of medical college in Seoul National University were included in this study. We performed lifestyle modification program consisting of lecture, group competition, and feedback. We focused on reforming health behaviors like smoking, drinking, exercise, stress management and eating habits. And we also checked common symptoms of functional diseases, medication frequency for relieving these symptoms and general life satisfaction. RESULTS: After 2 months of lifestyle modification program, the obese (P = 0.0455) and the average value of BMI (P < 0.001) were decreased and two of smokers quitted smoking. Numbers of medical students with health related habits such as regular exerciser (P = 0.027), frequent user of symptom-relief medication (P < 0.001), breakfast skipper (P = 0.005) were signifi cantly changed in positive way, and the average value of general life satisfaction score (P = 0.003) was improved. CONCLUSION: Lifestyle modification program improved medical students' health habits and enhanced general life satisfaction.
Breakfast ; Drinking ; Eating ; Health Behavior ; Humans ; Life Style ; Risk Factors ; Smoke ; Smoking ; Students, Medical

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method of sampling mediastinal lymph nodes to aid in diagnosing lymphadenopathy and in staging metastatic cancers. This paper describes a case of renal cell carcinoma with mediastinal and hilar lymph nodes metastasis that was diagnosed using EBUS-TBNA. A 17-year-old woman who had mediastinal lymphadenopathy and a right renal mass underwent imaging studies. The results of a first EBUS-TBNA suggested malignancy, but the type of tumor and exact site of the primary tumor were uncertain. Therefore, we repeated EBUS-TBNA with a lower pressure on the vacuum syringe. We successfully diagnosed the mediastinal lymph node metastasis from renal cell carcinoma.
Adolescent ; Biopsy, Needle ; Carcinoma, Renal Cell ; Female ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Needles ; Neoplasm Metastasis ; Syringes ; Vacuum

The use of the implantable Doppler device eases the burden of free flap monitoring, and allows caregivers to notify healthcare personnel of a potential vascular event. A 24-year-old female patient underwent anterolateral thigh adipofascial flap surgery to provide a buried flap on the left temporal area for a depressed and infected skull wound. The author was able to salvage the flap from two venous occlusions, which was made possible by early notifications from the caregiver who reported changes in the Doppler signal.
Caregivers* ; Delivery of Health Care ; Female ; Free Tissue Flaps* ; Humans ; Skull ; Thigh ; Ultrasonography, Doppler, Pulsed ; Wounds and Injuries ; Young Adult

The authors had five cases of penoplasty from more than half of the scrotum to the suprapubic region using a fasciocutaneous radial forearm free flap (RFFF) after extensive excision of sclerosing lipogranuloma. Although the harvested RFFF was a rectangular shape, the authors made the shape of scrotum, penile shaft, and suprapubic region by using well designed geometry and several quilting sutures on junction of scrotum and penis. The contour of scrotum and penis was well maintained, and there were no complications, such as scrotal contracture, penile deformity, and erectile dysfunction during the one year follow up period in all five cases. There were no recurrent lesions and no need for further surgery.
Congenital Abnormalities ; Contracture ; Erectile Dysfunction ; Follow-Up Studies ; Forearm* ; Foreign-Body Reaction ; Free Tissue Flaps* ; Granuloma ; Male ; Penis ; Scrotum* ; Sutures

PURPOSE: This study was performed to find out the natural history of lung cancer in Pusan-Kyungnam area and changing of that in previous report. MATERIALS AND METHOD: We studied retrospectively 508 patients with pathologically proven lung cancer from January 1991 to December 1995. We analysed age and sex distribution, initial symptoms before diagnosis, first method yielding histologic diagnosis, cell types of lung cancer, initial stage of lung cancer, schema of overall patients, survivial of lung cancer patients, and prognostic factors affecting survival of lung cancer patients.. RESULTS: The overall male to female ratio was 4.5: 1 and the age distribution ranged from 20 to 86 years, and the median age of overall patients was 60 years. Histologic classification revealed that the most prevalent type was squamous cell carcinoma (251 cases, 49.4%), followed by adenocarcinoma (141 cases, 27.8%), small cell carcinoma (91 cases, 17.9%), and large cell carcinoma (3 cases, 0.6%). In non-smali cell lung cancer 56.8% were stage IIIb and IV, therefore curative operation was done in 18.7% of all cases, but in small cell lung cancer 65.6% were extended disease. Meidan survival of overall patients was 11.8 months. There was a quite difference in survival among the stages. In non-small cell lung cancer, median survival was 59.7 months, 27.3 months, 18.5 months, 12.7 months, 5.9 months in stage I, II, IIIa, IIIb, IV in each. In small cell lung cancer, median survival of limited disese was 12.2 months and median survival of extended disease was 6.7 months. The stage and the performance status were independent prognostic factors in both small cell and non-small cell lung cancer. CONCLUSION: The prognosis of patients with lung cancer was still grave, but the survival was better than that of a previous report. This may be accorded to increase in early diagnosis and operation and advance in supportive care.
Adenocarcinoma ; Age Distribution ; Busan* ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Classification ; Diagnosis ; Early Diagnosis ; Female ; Gyeongsangnam-do* ; Humans ; Lung Neoplasms* ; Lung* ; Male ; Natural History ; Prognosis ; Retrospective Studies ; Sex Distribution ; Small Cell Lung Carcinoma