No abstract available.
Thoracic Wall* ; Thorax*

The widely prevailing Millard's rotation-advancement flap method is characterizes with the upper lip scar on a philtral column and that it is less conspicuous than LeMesurier's or Tennison's metheds. Nowadays, straight line closure methods are employed together with the Millard's. However there are still some problems which are a straight line closure that goes against the principle of plastic surgery, a noticeable scar, tenting of the peak of Cupid's bow, a short lip tendency, and depression of the lip when the muscle contracts. In this respect, we designed two or three small trapezoid skin flaps on the cleft side and the same number of releasing incision lines on the non-cleft side and then let them interdigitate one another. We called it dovetail cheiloplasty. The muscle work was done by suturing one third of the cleft side muscle to the dissected dermis of the non-cleft side skin flap just under the philtral dimple. Our patients had a primary incomplete, a microform type cleft lip or a secondary cleft lip deformity. The result of employing this method showed an inconspicuous scar, a shorter lip, and a natural formation of the philtrum. We believe this method induces the improvement of straight line closure with respect to the quality of scars and the morphology of an upper lip.
Cicatrix ; Cleft Lip ; Congenital Abnormalities ; Depression ; Dermis ; Humans ; Linear Energy Transfer ; Lip ; Microfilming ; Skin ; Surgery, Plastic

PURPOSE: This study was performed to elucidate the clinical pictures of acute focal bacterial nephritis(nephronia) in children. METHODS: We reviewed 9 children with nephronia diagnosed by ultrasonography or computed tomography of kidneys from September 1994 to August 2004. RESULTS: The overall male to female ratio was 2:1, and the age distribution ranged from 0.1 to 6 years(mean 2.8+/-2.2). The cardinal symptoms were fever, chills, abdominal pain and dysuria/frequency. The initial leukocyte count was 21,000+/-5,600/uL; ESR, 60+/-23 mm/hr; CRP, 17+/-10 mg/dl. Pyuria was noted in every patient and persisted for 10.5+/-7.8 days after antimicrobial treatment. Abdominal sonography demonstrated focal lesion of ill-defined margin and low echogenicity in 5 of 9 patients(55.6%), while computed tomography revealed nonenhancing low density area in all patients(100%). Three of 9 patients(33.3%) had vesicoureteral reflux, greater than grade III. The initial (99m)Tc-DMSA scan showed one or multiple cortical defects in every patient, and improvements were noted in 2(33.3%) of 6 patients who received follow up scan after 4 months. Intravenous antibiotics was given in every patient under admission. Total febrile period was 11.8+/-6.3 days(pre-admission, 4.0+/-3.0; post-admission, 7.8+/-5.5 days) and the patients needed hospitalization for 17.2+/-8.1 days. CONCLUSION: For the early diagnosis of 'acute focal bacterial nephritis' we should perform renal computed tomography first rather than ultrasonography, when the child has toxic symptoms and severe inflammatory responses in blood and urine.
Abdominal Pain ; Age Distribution ; Anti-Bacterial Agents ; Child* ; Chills ; Early Diagnosis ; Female ; Fever ; Follow-Up Studies ; Hospitalization ; Humans ; Kidney ; Leukocyte Count ; Male ; Nephritis* ; Pyuria ; Ultrasonography ; Vesico-Ureteral Reflux

Dextran are used as distension media to help visualize the uterine cavity during diagnostic and operative hysteroscopy and are also used for volume expansion and their antithrombogenic effect. But dextran have significant side effects including pulmonary edema, coagulation defects, anaphylaxis and acute renal failure. We experienced a case of pulmonary edema following hysteroscopic guided endometrial resection. A 41-year-old female was performed the operation under general anesthesia, and the time of tion was approximately 90 minutes, and 1000 ml of rheomacrodex(10% dextran 40 in 5% dextrose in water) was instilled during the procedure. At the end of the operation, we noted a drop in oxygen saturation, engorgement of neck vein and watery pink tinged sputum in the endotracheal tube. Chest x-ray was taken and showed pulmonary edema. The patient was transferred to the intensive care unit where therapy was instituted including positive pressure mechanical ventilation and negative balanced fluid therapy with intravenous push of furosemide. The patient was extubated after 1 day with ventilator care and transferred to general ward on 2nd postoperative day and discharged on 5th postoperative day without any complication.
Acute Kidney Injury ; Adult ; Anaphylaxis ; Anesthesia, General ; Dextrans* ; Female ; Fluid Therapy ; Furosemide ; Glucose ; Humans ; Hysteroscopy ; Intensive Care Units ; Neck ; Oxygen ; Patients' Rooms ; Pulmonary Edema* ; Respiration, Artificial ; Sputum ; Thorax ; Tolnaftate ; Veins ; Ventilators, Mechanical

We report on a case of successful management of a patient with abdominal aortic rupture requiring massive blood transfusion during the peri-operative period. The patient had fully recovered 19 days after the operation, through intra-operative cardiac arrest and massive transfusion. We analyze a process of blood transfusion and related complications resulting from massive transfusion in order to establish a treatment for peri-operative patients with hypovolemic shock.
Aortic Aneurysm, Abdominal* ; Aortic Rupture ; Blood Transfusion ; Heart Arrest* ; Humans ; Rupture* ; Shock

OBJECTIVES: Paranoia is a complex phenomenon, affected by a number of factors such as depression, trait anxiety, and attributional bias in schizophrenia. The aim of this study was to explore whether paranoia within continuum of clinical and subclinical states is associated with emotional dysregulation, attributional bias and neurocognitive impairment in whole individuals of normal controls, ultra-high risk (UHR) for psychosis and schizophrenia. METHODS: 101 normal controls, 50 participants at UHR for psychosis, and 49 schizophrenia patients were recruited. All subjects were asked to complete self-reported paranoia scale and emotional dysregulation scales including Rosenberg's self-esteem, Spielberg's state-trait anxiety inventory and Beck depression inventory. The attributional style was assessed by Ambiguous Intentions Hostility Questionnaire (AIHQ). Participants were also requested to complete the comprehensive neurocognitive battery. RESULTS: Multiple linear regression analysis showed that paranoia were found to be associated with emotional dysregulation (state anxiety, trait anxiety and depression), composite blaming bias in ambiguous situation, impairment of attention and working memory in whole participants [F (9, 190)=34.85, p<0.001, adjusted R2=0.61]. CONCLUSION: The main findings suggest that paranoia is a complex affective and cognitive structure that may be associated with emotional dysregulation, blaming bias and attention and working memory impairment in clinical and non-clinical paranoia.
Anxiety ; Bias (Epidemiology)* ; Depression ; Hostility ; Humans ; Intention ; Linear Models ; Memory, Short-Term ; Paranoid Disorders* ; Psychotic Disorders* ; Surveys and Questionnaires ; Schizophrenia* ; Weights and Measures

Inability to synthetize adequate amounts of IL-2 has been suggested to be the basis of defective T-cell function following anesthesia with the operation. The present study was designed to examine the effect of anesthesia and operation on host defence mechenism. serum soluble IL-2R(sIL-2R) levels and hemo-dynamic parameters were measured in 30 patients. Patients were divided into two groups (G: general anesthesia with isoflurane, E:epidural anesthesia with bupivacaine) according to the method of anesthesia. Venous blood samples were taken before anesthesia(T1), 10 mins after induction of anesthesia(T2), 10 mins after injection of bupivacaine in epidural anesthesia(T2), 1 hour after skin incision(T3), 30 mins after completion of operation(T4), and 24 hours after completion of operation(T5). Simultaneously arterial blood pressure and heart rate were measured. Six mililiter of perip-heral blood was obtained for sIL-2R studies in plain tubes. Serum concentration of sIL-2R was measured by human IL-2 receptor ELISA kit(Boehringer Mannheim Biochemica, Mannheim, Germany). Any significant change in IL-2R level was not seen in patients under general anesthesia with isoflurane and operation. Also any significant change in IL-2R level was not seen in patients who had an epidural anesthesia with bupivacaine and operation. The results suggest that suppression of T-lymphocyte function and decrease in lymphocyte counts induced by anesthesia and operation is not due to alteration of intracellular metabolism, but due to extracellular immune depressor. And general anesthesia operation with isoflurane as well as epidural anesthesia with bupivgcaine is safe and can be selected for immunosuppressive patients.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General* ; Arterial Pressure ; Bupivacaine* ; Enzyme-Linked Immunosorbent Assay ; Heart Rate ; Humans ; Interleukin-2* ; Isoflurane* ; Lymphocyte Count ; Metabolism ; Receptors, Interleukin-2 ; Skin ; T-Lymphocytes

Takotsubo cardiomyopathy, also called stress-induced cardiomyopathy, usually occurs in patients with severe emotional or physiologic stress. The prognosis is favorable, and the wall motion abnormlities normalize within weeks. However, stress-induced cardiomyopathy is rarely assosicated with left ventricular thrombus and thromboembolic complications. Here, we report a case of stress-induced cardiomyopathy with left ventricular thrombus that embolized to cause cerebral infarction.
Cardiomyopathies ; Cerebral Infarction ; Humans ; Prognosis ; Takotsubo Cardiomyopathy ; Thrombosis

BACKGROUND: The several forms of treatment of Graves disease-thyroidectomy, antithyroid drugs and radioiodide therapy-are in wide use now. But which therapy is best is a matter of debate. Some authors reported that in patients who underwent thyroidectomy, higher titers of serum antimicrosomal antibody were associated with 1) higher formation rates of germinal centers, 2) more lymphocyte infiltration in the thyroid tissue, 3) higher incidence of hypothyroidism, and 4) lower incidence of recurrence. We were interested in the relationship of thyroid autoantibody titers, ADCC(antibody-dependent cell-mediated cytotoxicity) activity and the clinical response to antithyroid medication. METHODS: We measured ADCC activities from patients in Graves disease(n-48), Hashimoto thyroiditis(n=17) and normal control(n=9). The patients of Graves disease were followed up for more than 1 year, and they were grouped into A(n=17, well responsed group to antithyroid medication) and B(n=31, poorly responsed group). We examined ADCC activities of patients' sera by chromium release assay. RESULTS: 1) Mean age of patients with Graves disease was 34.4210.4 years and 15 patients were male(31%). 2) Results of thyroid function tests of the Graves' patients were T 585.9 +/- 255.3 ng/dL, T4 21.3 +/- 12.2 mg/dL, TSH 0.11 +/- 0.06mIU/mL. Concentrations of antimicrosomal antibody, antithyroglobulin antibody and thyrotropin binding inhibitory immunoglobulin were 1279.1 +/- 1486.7 IU/mL, 488.1 +/- 751.1 IU/mL, and 38.5 +/- 33.4U/L respectively. 3) There was no significant difference between levels of thyroid hormones or concentrations of thyroid autoantibodies and ADCC activities in graves patients. 4) The ADCC activity of the Graves patient group(24.49%) was significantly higher than that of the normal control group(3.76%), and significantly lower than that of the Hashimotos thyroiditis group(36.34%). 5) There was no significant difference in ADCC activity between group A(18.24 +/- 13.44%) and B(27.91 +20.02%). CONCLUSION: From this results, we suggested that ADCC activity seems to be no value as a prognostic factor in predicting the response to antithyroid drugs in Graves disease patients. But, further studies, larger number of patients and long-term follow up, are needed.
Antibody-Dependent Cell Cytotoxicity ; Antithyroid Agents ; Autoantibodies ; Chromium ; Follow-Up Studies ; Germinal Center ; Graves Disease* ; Humans ; Hypothyroidism ; Immunoglobulins ; Incidence ; Lymphocytes ; Recurrence ; Thyroid Function Tests ; Thyroid Gland ; Thyroid Hormones ; Thyroidectomy ; Thyroiditis ; Thyrotropin

In patients with acute ischemic stroke, early treatment with thrombolytic agents is thought to permit reperfusion to ischemic but still viable brain areas and to promote recovery of function. However, reocclusion and hemorrhagic transformation may occur after thrombolysis and these are major factors of no-improvement or deterioration despite the initial successful recanalization. Reocclusion occurs frequently during or immediately after successful recanalization, often silently. In the case of reocclusion, initial platelet-fibrin thrombi are converted into platelet-rich thrombi by platelet-mediated thrombotic mechanisms. Therefore, if can be effectively resolved by use of the platelet membrane glycoprotein IIb/IIIa receptor inhibitors such as abciximab. Hemorrhagic transformation (HT) is a well-known factor limiting the use of thrombolytics and negating the effect of the treatment. Recent studies demonstrate that loss of integrity of the blood-brain barrier in association with active proteolytic degradation of vascular extracellular matrix is a key molecular pathway leading to HT. Therapeutic strategies to prevent reocclusion and HT by use of agents that act against these mechanisms before or during thrombolysis are warranted to enhance the efficacy of reperfusion therapy in stroke.
Blood Platelets ; Blood-Brain Barrier ; Brain ; Cerebral Infarction ; Extracellular Matrix ; Fibrinolytic Agents ; Humans ; Membrane Glycoproteins ; Recovery of Function ; Reperfusion ; Stroke ; Thrombolytic Therapy*