A secondary cleft lip nasal deformity can be corrected by many procedures including central lip tissue transfer, forked flap, nasal floor and alar base advancement, nasal skin flaps and composite graft. These procedures have been applied for many years, but each one has some conspicuous residual problems. We propose triple V-Y advancement flaps, which we have performed on 13 secondary cleft lip and nasal deformity patients over the past 6 years. The W-shaped triple reverse V-shaped incision easily exposed the alar cartilages. We made the advancement and rotation of the nasal skin flap to lengthen the columella and project the nasal tip. Postoperatively, the columella length and nasolabial angle were found to be increased by an average of 3.7 mm and 42 degrees, respectively. In lateral view, a relatively natural nasal line was achieved. The scar in the nasal tip posed few problems. This procedure should be useful for the correction of the secondary cleft lip nasal deformity.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities* ; Humans ; Lip ; Skin ; Transplants

PURPOSE: Hypertrophic osteoarthropathy(HOA) is a clinical syndrome consisting of clubbing, periostitis and synovitis. Most frequent causes of hypertrophic osteoarthropathy are intrathoracic neoplasms, among which the bronchogenic carcinoma ranks the highest. But computed tomographic evaluation of intrathoracic neoplasm associated with HOA has been seldom reported. The purpose of this study is to evaluate CT findings of intrathoracic neoplasm associated with HOA, and to infer possible mechanism. MATERIALS AND METHODS: Seven cases of intrathoracic neoplasm associated with HOA were included in our study. Diagnoses of HOA were made by Tc99m bone scintigraphy or plain radiography. The findings of chest CT scans were reviewed retrospectively, with main interests on their size, location and internal characteristics, ect. RESULTS: Seven cases of intrathoracic neoplasm consisted of five bronchogenic carcinomas and two thymic tumors. The size of intrathoracic tumors were relativelY, large ranging from 6cm to 13cm(average 8.0cm). All thoracic neoplasms showed wide pleural contact, and one of them invaded thoracic wall. The range of length of pleural contact was 5-18cm(average 9.9cm). All of seven patients had internal necrosis, and one of them showed cavitation in thoracic mass. CONCLUSION: lntrathoracic neoplasms associated with HOA had a tendency to be large, to contain internal necrosis, and to widely abut the thoracic pleura.
Carcinoma, Bronchogenic ; Diagnosis ; Humans ; Necrosis ; Periostitis ; Pleura ; Radiography ; Radionuclide Imaging ; Retrospective Studies ; Synovitis ; Thoracic Neoplasms ; Thoracic Wall ; Thymus Neoplasms ; Tomography, X-Ray Computed

No abstract available.
Emergency Medicine*

No abstract available.
Glomerular Filtration Rate* ; Kidney*

Biliary ascariasis is a rare complication of intestinal ascaris infestation. Retrograde migration of the adult worm through the papilla of Vater causes biliary colic, and may give rise to pancreatic and biliary obstruction, choledocholithiasis, cholecystitis, cholangitis, hemobilia, and if the worm lodges in intrahepatic bile ducts, to liver absceases. In the past, treatment of biliary ascariasis has usually involved the direct removal of ascaris throagh a surgical choledochatomy and subsequent saline lavage of the common duct through an indwelling T tube. Recently, the worm in the bile duct can be seen by ERCP and it can be removed during the endoscopic procedure. A 55-year-old woman with intermittent colicky right upper quadrant abdominal pain was admitted to out hospital. Abdominai sonogram disclosed an echogenic structure within a mildly dilated common bile duct and a high ehogenic structure with acoustic shadowing in the distal common bile duct(CBD), which suggests a CBD stone. ERCP after obtaining the sonogram revealed a thick, long, linear, smooth filling defect in the CBD with a distal CBD stone. A distal CBD stone was removed by sphinctetotomy and lithotripsy, then we directly extracted ascaris with a tripod forcep without any complication.
Abdominal Pain ; Acoustics ; Adult ; Ascariasis* ; Ascaris ; Bile ; Bile Ducts ; Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystitis ; Choledocholithiasis ; Colic ; Common Bile Duct* ; Female ; Hemobilia ; Humans ; Lithotripsy ; Liver ; Middle Aged ; Shadowing (Histology) ; Surgical Instruments ; Therapeutic Irrigation

The diagnostic work-up of renal mass should be carried out in an accurate, rapid, noninvasive and cost effective way. We retrospectively analyzed the diagnostic accuracy of ultrasonography, computerized tomography and renal angiography in 33 patients with renal mass from July 1984 to June 1987. The results were as follows : 1. The sex distribution of renal masses were 22 cases in male and 11 cases in female, and mean age of male patients were 43.8 years and female were 44.3 years. 2. The most common presenting symptom was flank pain in 28 cases(82.4%) and 17 cases (50.0%) presented with painless gross hematuria and one patient had no symptom. 3. Diagnostic accuracy of ultrasonography, computerized tomography and renal angiography of 27 cases of renal mass, were 70.6%, 83,3% and 63.3%, respectively. 4. Among 33 cases of renal mass, operation was done in 27 cases and 7 cases were misdiagnosed. 5. Therefore, we think that current uroradiologic studies are not sufficiently accurate in the diagnosis of renal mass and that exploration should be done whenever the diagnosis of renal mass is equivocal by radiologic study.
Angiography ; Diagnosis ; Female ; Flank Pain ; Hematuria ; Humans ; Male ; Retrospective Studies ; Sex Distribution ; Ultrasonography

The diagnostic work-up of renal mass should be carried out in an accurate, rapid, noninvasive and cost effective way. We retrospectively analyzed the diagnostic accuracy of ultrasonography, computerized tomography and renal angiography in 33 patients with renal mass from July 1984 to June 1987. The results were as follows : 1. The sex distribution of renal masses were 22 cases in male and 11 cases in female, and mean age of male patients were 43.8 years and female were 44.3 years. 2. The most common presenting symptom was flank pain in 28 cases(82.4%) and 17 cases (50.0%) presented with painless gross hematuria and one patient had no symptom. 3. Diagnostic accuracy of ultrasonography, computerized tomography and renal angiography of 27 cases of renal mass, were 70.6%, 83,3% and 63.3%, respectively. 4. Among 33 cases of renal mass, operation was done in 27 cases and 7 cases were misdiagnosed. 5. Therefore, we think that current uroradiologic studies are not sufficiently accurate in the diagnosis of renal mass and that exploration should be done whenever the diagnosis of renal mass is equivocal by radiologic study.
Angiography ; Diagnosis ; Female ; Flank Pain ; Hematuria ; Humans ; Male ; Retrospective Studies ; Sex Distribution ; Ultrasonography

The dangers of explosion hazards and operation theater contamination by inhalation anesthetics have led to a renewed interest in intravenous anesthesia. without intubation. We have reported clinical studies of Thalamonal-ketamine anesthesia under room air breathing in non-abdominal surgery in a previous paper that discussed advantages, disadvantages and usefulness. Now, we report Thalamonal-N2O-Ketamine anesthesia with a microdrip technique and intubation in 63 patients undergoing various operations. These patients were divided into three groups by operation site: Group 1-upper abdominal, Group 2-lower abdominal and Group 3-non-aMominal surgery. These groups were subdivided, by muscle relaxants used, into pancuronium, d-tubocurarine and no relaxant groups. To minimize potential cardiovascular stimulation and postoperative sequelae, ThalamonaI was used at the beginning of anesthesia. The results were as follows: 1) The average duration of anesthesia was 153.9 minutes. The duration of anesthesia was 217.9 minutes in Group I, 121.9 minutes in Group 2 and 152.1 minutes in Group 3. 2) The average dose of ketamine-during induction was 1mg/kg/19 minutes. The average maintenance dose of ketamine was 1.8mg/kg/hr, 2.3mg/kg/hr in Group 1, 1.6mg/kg/hr in Group 2 and 1.8mg/kg/hr in Group 3. 3) The order of frequency of administration and total dose of pancuronium and d-tubocurarine was Group 1, Group 2 and Group 3. 4) The changes in vital signs after intubation and during anesthesia were insignificant clinically. 5) The average duration required from the end of operation to extubation was 10 minutes. 6) Arterial blood gas study performed preoperatively, during operation and in the recovery room in 11 patients revealed no significant changes. 7) The postanesthetic complications were pleasant dreams 18% (11), unpleasant dreams 6% (4), emergence delirium 3% (2), vomiting 6% (4) and shivering 3% (2).
Anesthesia ; Anesthesia, Intravenous ; Anesthetics, Inhalation ; Delirium ; Dreams ; Explosions ; Humans ; Intubation ; Ketamine* ; Pancuronium ; Recovery Room ; Respiration ; Shivering ; Tubocurarine ; Vital Signs ; Vomiting

A case of Agenesis of gallbladder in 73-year old female patient who had an emergent operation due to obstructive jaundice with impacted CBD stones is reported. The patient suffered from icteric sclera and abdominal pain which waxed and waned for three days. Impacted CBD stones and an agenesis of the gallbladder was suggested by a computed tomogram of the abdomen. In the operating field, multiple adhesions around the biliary tree was noticed, but we could not find the gallbladder and cystic duct. She underwent choledocholithotomy, T-tube choledochostomy, operative cholangiography, and drainage. Operative cholangiogaphy showed no remained stones, and there was no structures suggesting gallbladder and cystic duct. The authors described the case with a recent review from the literature.
Abdomen ; Abdominal Pain ; Aged ; Biliary Tract ; Cholangiography ; Choledochostomy ; Cystic Duct ; Drainage ; Female ; Gallbladder* ; Humans ; Jaundice, Obstructive ; Sclera

No abstract available.
Breast Neoplasms* ; Breast*