High septal deformities exert pressure on upper lateral cartilages and nasal bones and cause external deviation of the nose. However, detection of high septal deformities causing deviated noses is very difficult if a detailed intranasal examination is not performed. As well, the high septal border is a difficult area to approach via the endonasal rhinoplasty and is the weakest portion in the septum resulting in much difficulty in correcting deformities and in frequent later recurrence of deviation secondary to the healing process. In order to solve the above problems in 33 cases of deviated nose associated with high septal deformities, the authors evaluated deformities in the high septal border after separation of the septum from upper lateral cartilages and nasal bones. The high septal border is centralized by scoring after resection of the mid or lower-septal portion. And spreader grafts were applied to the convex sides of deviated septal borders to stabilize the high septal border and to prevent long-term recurrence of deviation. Also, to balance the traction force of side walls, the length of both upper lateral cartilages and nasal bones were equalized by resection in the longer side and grafting in the shorter side. Clinical follow-up ranged from 3 to 31 months. There was no surgical or septal complication. Also, there was no incomplete correction, recurrence of deviation, or compromized nasal support. All patients except 2 were satisfied with the aesthetic and functional results. We found that separation of septum from side walls allows detection and correction of higher septal deformities and that spreader graft allows long-term support and prevents later recurrence of deviation.
Cartilage ; Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Nasal Bone ; Nose* ; Recurrence ; Rhinoplasty ; Traction ; Transplants*

No abstract available.
Skin*

The use of a cultured autologous keratinocyte sheet has become a recognized method for the coverage of extensive bums during recent years. The disadvantages of these sheet grafts are a long time-lag until keratinocyte sheets are available, the fragility and difficulty in handling of grafts, an unpredictable take rate and extremely high costs. In this study we investigated the transplantation of cultured keratinocytes as single cells suspended in autologous fibrin glue. In a rat model with standardized full thickness wounds, this new transplantation technique was evaluated and compared directly to the conventional keratinocyte sheet grafting technique. After transplantation, wounds were evaluated for the degree of epithelial coverage, and then microscopic structures were evaluated under light and electron microscopy. The results were as follows: 1) The fibrinogen solution prepared from autologous blood had 12 times more fibrinogen compared to the original blood. 2) After transplantation of cultured keratinocyt-es in fibrin glue, the degree of epithelial coverage was 79% at 2 weeks, which was comparable to 17% for cultured keratinocyte sheet graft 3) Typical basement membrane structures were consistently found at 2 weeks after transplantation of keratinocytes in fibrin glue. 4) Rete ridges were found at 4 weeks after transplantation of keratinocytes in fibrin glue. In conclusion, the transplantation technique of keratinocytes in fibrin glue is available earlier than sheet grafts, it transfers actively proliferating cells and it simplifies the grafting procedure. As well, this technique leads to an earlier epithelial covering and an earlier restoration of the dermo-epidermal junction than sheet grafting.
Basement Membrane ; Fibrin Tissue Adhesive* ; Fibrin* ; Fibrinogen ; Keratinocytes* ; Microscopy, Electron ; Models, Animal ; Transplants ; Wounds and Injuries

No abstract available.
Pneumothorax* ; Risk Factors*

The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.
Administration, Intravenous ; Amnesia ; Anesthesia ; Blood Pressure ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Premedication*

We report a case of successful heart transplantation after 67 days of support with venoarterial extracorporeal membrane oxygenation (ECMO) in a patient who underwent surgery for type A aortic dissection and myocardial infarction complicated by irreversible myocardial damage and a deep sternal wound infection. During ECMO support, left heart vent and distal limb perfusion were performed. Mediastinitis was treated with mediastinal washout and irrigation. Multiple complications from peripheral ECMO were successfully managed.
Cardiomyopathies ; Extracorporeal Membrane Oxygenation* ; Extremities ; Heart Transplantation* ; Heart* ; Humans ; Mediastinitis* ; Myocardial Infarction ; Perfusion ; Shock ; Transplantation ; Wound Infection

PURPOSE: To evaluate the therapeutic efficacy of intravitreal bevacizumab (IVB) in the treatment of branch retinal vein occlusion (BRVO) in eyes with normal tension glaucoma (NTG). METHODS: We included 16 NTG eyes and 48 age- and sex-matched eyes without NTG that had received IVB for BRVO with more than 6 months of follow-up. The main outcome measures were log MAR best-corrected visual acuity (BCVA) and central macular thickness (CMT) at baseline and 1, 3, and 6 months after IVB. We compared the results according to the comorbidity associated with NTG. RESULTS: The obstruction site of BRVO was significantly closer to the optic disc in eyes with NTG than in eyes without NTG. Baseline log MAR BCVA and CMT were similar between the two groups. After IVB, postoperative BCVA was significantly improved and CMT was significantly reduced, irrespective of the comorbidity associated with NTG. However, vision improvement was more limited in eyes with NTG, while CMT was similarly reduced compared with that in eyes without NTG. The mean numbers of injections were similar between the two groups, and there were no injection-related complications. CONCLUSIONS: IVB may have therapeutic efficacy in the treatment of BRVO associated with NTG. However, the comorbidity associated with NTG may limit vision improvement, although anatomic recovery of CMT is achieved.
Antibodies, Monoclonal, Humanized ; Comorbidity ; Eye ; Follow-Up Studies ; Low Tension Glaucoma ; Macular Edema ; Outcome Assessment (Health Care) ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Vision, Ocular ; Visual Acuity ; Bevacizumab

The use of artificial skins for full thickness wounds is an accepted technique, but unfortunately the take rate is low and the aesthetical result is not acceptable. The freeze-drying treatment of allogenic tissues can destroy cells with preserving the structural organization of extracellular matrices, permitting allogenic transplantation. In this study we investigated a new method to process the allogenic skin for transplantable allogenic dermis and this dermis was evaluated in a full thickness wound model. The results are as followings; 1. After treatment with NaCl and SDS solution and then with freeze-drying method, the allogenic dermis shows acellular dermal matrix with preserved normal extracellular matrix. 2. This allogenic dermis became completely incorporated into the wound without evidence of rejection or replacement by scar tissue. 3. The take rate of thin autografts overlying the allogenic dermis that were applied simultaneously was comparable to take rate of autograft alone. 4. The reduction in secondary contraction by allogenic dermis treated wounds was significant. 5. After grafting with cultured keratinocytes, the degree of epithelial coverage was 70% at 2 weeks. In conclusion, the allogenic dermis processed with our method displayed lack of antigenicity, and rapid revascularization. This allogenic dermis can permit simultaneous engraftment of an overlying STSG or cultured kerationocytes, reduce secondary contraction and improve cosmesis of full thickness wounds.
Acellular Dermis ; Autografts ; Cicatrix ; Dermis* ; Extracellular Matrix ; Keratinocytes ; Skin ; Skin, Artificial ; Transplants ; Wounds and Injuries*

Prior to 1988, endometrial cancer was clinically staged but there was the considerable discrepancy between clinical and aetual stage. FIGO surgical staging classification of endometrial cancer(I988) provides the advanatage of recognizing the true disease distribution and extension, and more rational treatraent can be accomplished. This retrospective study was based on a clinical review of 73 patients with endometrial carcinoma from l982 through 1991 who underwent primary surgical evaluation. A11 cases were restaged ueing the newly adopted FIGO surgical staging. The distribution of FIGO clinical staging was as follows:85 patients(89.1%) were with stage I, 5(6.9%) with stage II, 2(2.7%) with stage III and 1(l.3%) with stage IV. Surgical restaging according new FlG0 classification reveald 56(76.7%) patients with stage I, 1(1.4%) with stage II, 14(19.2%) with stage III and 2(2.7%) with stage IV. Surgery upstaged 12.3% of clinical stage I patients, In clinical stage II patients, 80.0% was doenstaged. There wes no stage changing in cliaical stage III and IV patients. The acturial survival rates for surgical stages I a, I b, I c, and III were 80.0%, 77.2%, 68.4A%, and 35.0% respectively. By using FIGO surgical staging, the initial extent of endometrial cancer can be more accurately evaluated and we may predict prognosis and survival relatively well.
Classification ; Endometrial Neoplasms* ; Female ; Humans ; Prognosis ; Retrospective Studies ; Survival Rate

The result of artificial skins made with collagen is poor after grafting over the full thickness wounds due to their rapid degradation by enzymatic cleavage. This study is an in vivo study of an artificial skin made with a biodegradable polymer, which can better address the problem of the collagenous artificial dermis. To investigate the availability of a biodegradable polymer for an artificial dermis and to get an information about the optimal degradation rate of a polymer for an artificial dermis, we made an artificial dermis by seeding of fibroblasts within the vicryl mesh and made a bilayer artificial skin by covering the artificial dermis with cultured keratinocytes. And these artificial dermis and artificial skin were evaluated in a full thickness wound model. The results are as followings: 1. The artificial dermis was available for grafting for 1 week culture of vicryl mesh-fibroblast. 2. The artificial dermis retarded the contraction of full thickness wounds. 3. The artificial dermis generated the granulation tissue and accepted the STSG completely. 4. The generated tissue from the artificial dermis had incorporated into the surrounding tissue by 4 weeks postgrafting. 5. Vicryl in the artificial dermis became to biodegrade from the culture period and absorbed completely by 5 weeks. 6. The epidermal portion was poorly differntiated during in vitro culture period. In conclusion, the polymer-fibroblast graft can retard the wound contraction and generate a new tissue permitting a useful dermal replacement. And to get more optimal results, another polymer which has slower biodegradation rate than vicryl should be used for the artificial dermis and the epidermal portion should be differentiated after in vivo grafting.
Collagen ; Dermis* ; Fibroblasts ; Granulation Tissue ; Keratinocytes ; Polyglactin 910 ; Polymers ; Skin, Artificial ; Transplants ; Wounds and Injuries