No abstract available.

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

No abstract available.
Appendicitis* ; Barium* ; Enema*

As the traffic accidents and occupational accidents increase, the pure blow out fracture has been increased. If we could know the prognostic information of the pure blowout fracture according to the fracture sites, it would be of benefit in consulting the patients preoperatively and in planning the treatment. In this study we defined the posterior wall fracture as that extending 2 cm from orbital rim and the anterior wall fracture as that presenting within 2 cm from orbital rim. These fractures were individually classified into inferior wall fractures, medial wall fractures, and combined inferior and medial wall fractures, based on the operative finding and the preoperative CT scanning. We experienced 76 cases of pure blowout fracture patients underwent surgical correction and followed up the subsidence of diplopia and extraocular muscle limitation with ophthalmic Hess test. The results obtained are as following: 1. Posterior wall fractures were improved more slowly than anterior wall fractures. 2. Combined inferior and medial wall fractures were improved more slowly than isolate inferior wall or medial wall fractures. These results may be related to the difference of the traumatic forces and the anatomical structure of the fracture sites. These results inform the importance of accurate anatomical reconstruction of fracture sites and can be used as a prognostic information of the pure blow out fractures.
Accidents, Occupational ; Accidents, Traffic ; Diplopia ; Humans ; Orbit ; Orbital Fractures* ; Tomography, X-Ray Computed

Together, the cheek and neck can be considered as a single anatomic location because skin vascularity, texture and thickness are similar. The cervicofacial flap has been described as the treatment of choice for the cheek defect because of its good mobility and excellent cosmetic result. However, if the defects on the cheek are wider than the length of palpebral fissure of extended to the lower two thirds of the cheek, the conventional cervicofacial flaps would be inadequate in size without the benefit of expansion. Tissue expansion of the cheek and neck is distinguished by a particuarly high rate of complication. Prevention of various complications require careful planning and certain modifications in technique. We have used the following modifications and measures to prevent the complications and to maximize the expansion. 1) Whenever possible, expanders were placed over the rigid foundation such as mandible or posterior neck area after wide undermining. 2) Expanders were placed deep to platysma in the neck area. 3) Following optimal expansion, the further dissection extending to the clavicle and the posterior neck area was performed for optimal mobilization and draping of the expanded skin. 4) The expanded skin was advanced upward on the cervical portion and rotated forward on the cheek portion. 5) The flap should not be draped above the inferior orbital rim and postoperatively the pressure garments were applied to prevent drooping of the expanded skin. We experienced 21 cases of the expanded cervicofacial flaps with above surgical modifications and the expanded cervicofacial flaps can resurface the 95% of cheek defects with minimal complications and excellent cosmetic results.
Cheek* ; Clavicle ; Mandible ; Neck ; Orbit ; Skin ; Tissue Expansion

This is a case report of salivary gland tumors developed at buccal fat pad and masseteric area which are considered rare and characterized by asymptomatic mid-cheek mass. Three cases were diagnosed as accessory parotid gland tumor and the other 3 cases as minor salivary gland tumor with tissue pathology. Accessory parotid gland lies 6 mm anterior to the main parotid gland and accessory parotid gland tumors represent 1% of all parotid tumor. It can be managed solely by resection of the accessory parotid gland without superficial or total parotidectomy. Minor salivary gland tumors represent 10-20% of all salivary gland tumor and are usually found on the palate, paranasal sinuses and cheek. Buccal minor salivary gland tumors are usually found incidentally as submucosal mass at buccal mucosa and managed by wide excision including 1-2 cm free margin through intra-oral approach. This paper reviews our experience with these unusual tumors in terms of clinical manifestation, radiologic findings and the acceptable surgical management.
Adipose Tissue ; Cheek ; Mouth Mucosa ; Palate ; Paranasal Sinuses ; Parotid Gland ; Pathology ; Salivary Glands* ; Salivary Glands, Minor

The p53 oncoprotein, a product of the tumor suppressor gene encoded on the short arm of chromosome 17, has been noted in a number of human tumors as a tumor suppressor and some what has been related with cellular apoptosis. Thus, mutant p53 inhibits apoptosis. Like the mutant p53 oncoprotein, the bcl-2 oncoprotein expressed in various epithelial and nonepithelial cells plays a major role in inhibiting cellular apoptosis. To elucidate the role of bcl-2 and mutant p53 oncoprotein expression in gastric adenocarcinomas, immunohistochemical stains were carried out in 60 cases of gastric adenocarcinomas including 10 cases of early gastric cancer. We studied the expression patterns of the bcl-2 and the mutant p53 protein according to age, sex, histologic differentiation, tumor location, tumor size, lymph-node involvement, and depth of tumor invasion. The results were as follows: 1) p53 protein expression was detected in 39 of 60 cases (65%), and bcl-2 protein expression was detected in 29 of 60 cases (48%). 2) The p53 and the bcl-2 expression rates for early gastric cancer were 60% and 50%, and those for advanced gastric cancer were 66% and 40%, respectively. 3) There was no significant correlation of p53 or bcl-2 expression with sex, age, histologic differentiation, tumor location, tumor size, and lymph-node involvement; however, the expression of p53 was correlated with the depth of tumor invasion (p=0.049). Based on the present study, the expression of p53 is thought to be correlated with tumor progression and may be a useful prognostic factor in gastric adenocarcinomas.
Adenocarcinoma* ; Apoptosis ; Arm ; Chromosomes, Human, Pair 17 ; Coloring Agents ; Genes, bcl-2* ; Genes, p53* ; Genes, Tumor Suppressor ; Humans ; Immunohistochemistry ; Stomach Neoplasms

PURPOSE: This study aimed to analyze stress distribution and maximum von Mises stress generated in intracoronal restorations and in tooth structures of mandibular molars with various types of cavity designs and materials. MATERIALS AND METHODS: Threedimensional solid models of mandible molar such as O inlay cavity with composite and gold (OR-C, OG-C), MO inlay cavity with composite and gold (MR-C, MG-C), and minimal invasive cavity on occlusal and proximal surfaces (OR-M, MR-M) were designed. To simulate masticatory force, static axial load with total force of 200 N was applied on the tooth at 10 occlusal contact points. A finite element analysis was performed to predict stress distribution generated by occlusal loading. RESULTS: Restorations with minimal cavity design generated significantly lower values of von Mises stress (OR-M model: 26.8 MPa; MR-M model: 72.7 MPa) compared to those with conventional cavity design (341.9 MPa to 397.2 MPa). In tooth structure, magnitudes of maximum von Mises stresses were similar among models with conventional design (372.8 – 412.9 MPa) and models with minimal cavity design (361.1 – 384.4 MPa). CONCLUSION: Minimal invasive models generated smaller maximum von Mises stresses within restorations. Within the enamel, similar maximum von Mises stresses were observed for models with minimal cavity design and those with conventional design.
Bite Force ; Dental Enamel ; Finite Element Analysis ; Inlays ; Mandible ; Molar ; Tooth

Bacillus Calmette-Guerin(BCG) has been widely used for the prophylaxis of superficial bladder tumor recurrence and for the treatment of bladder carcinoma in situ. More than 95% of patients who receive BCG instillation tolerate the treatment well and side reactions have been reported in less than 5% of patients. Most side effects are minor and self-limiting. However, a rear occurrence of severe systemic reactions have been reported. Among the severe systemic reactions, hypersensitivity pneumonitis should be considered in patients with pneumonic complications after BCG instillation in cases where the culture for mycobacteria is negative in the sputum, brochoalveolar lavage and blood specimen. In addition, a fiberoptic bronchoscopy with transbronchial lung biopsy demonstrates a fibrosis of the alveolar septums, where there is and an increased lymphocyte count without tuberculous inflammatory changes, the and CD4:CD8 ratio is increased and no symptomatic response to antituberculosis chemotherapy is observed. Here we report a 68 years old man with interstitial pneumonitis following intravesical BCG instillation.
Administration, Intravesical* ; Alveolitis, Extrinsic Allergic ; Bacillus ; Biopsy ; Bronchoscopy ; Carcinoma in Situ ; Drug Therapy ; Fibrosis ; Humans ; Lung ; Lung Diseases, Interstitial* ; Lymphocyte Count ; Mycobacterium bovis* ; Recurrence ; Sputum ; Therapeutic Irrigation ; Urinary Bladder Neoplasms* ; Urinary Bladder*

We report a case of huge seminal vesicle cyst associated with ipsilateral renal agenesis in a 49-year-old man with frequency, urethral discomfort with a full bladder, and tenesmus as complaints.
Humans ; Middle Aged ; Seminal Vesicles* ; Urinary Bladder