The basic criteria of facial reconstruction with the flap are consisted of easy and wide applicability, good color and texture matching to the face and reliable anatomical basis. On these points, the submental island flap is superior to other regional flaps such as tissue expansion technique and free flaps It is based on the submental vessels branching from the facial vessels located at the medial groove of submandibular gland. Its pedicle has a reliable course along the inferior border of mandible with a constant distance and its perforator(s) is (are) located at the submental area around the anterior belly of digastric muscle. We report on its use in 4 cases of facial resurfacing on the cheek, the preauricular area and the nose in arteriovenous malformation and malignant skin cancer patients. The mylohyoid and anterior belly of digastric muscles could be included within the flap and the reverse submental island flap was also useful for obtaining the wide rotation of arc. The mean follow-up period was 8.3 months and the results were satisfactory to the patients. The submental island flap is reliable flap for facial resurfacing because of its good color and texture, acceptable donor scars, and thin, flexible flap. The flap also can incorperate with the skin, the muscle, and the bone in case of complicated facial defects. The long vascular pedicle also enables a wide applicability of the flap And also it can be used as a free flap, expanded flap and reverse island flap for the facial resurfacing.
Arteriovenous Malformations ; Cheek ; Cicatrix ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Mandible ; Muscles ; Nose ; Skin ; Skin Neoplasms ; Submandibular Gland ; Tissue Donors ; Tissue Expansion

There are some effective methods for removing layers of skin to improve aging face and dermatologic defects : chemabrasion (chemical peeling), dermabrasion(surgical removal), laserabrasion. Chemabrasion, generally performed with a chemical solution, is most useful for removal of fine facial wrinkles and abnormal pigmentation. The application of chemical caustics, especially TCA (trichloroacetic acid), is known to be an effective and is now commonly practiced to improve the surface of the facial skin that has been blemished by pigmentation, wrinkles, solar damage and certain scars. Trichloroacetic acid is a colorless melting crystal and derivatives of acetic acid which das protein precipitating properties. It has specific odor but there is not systemic toxic effect like a phenol. It has heavy caustic effect on skin and mucosa and cause the coagulation necrosis of the skin and therefore, it must be handled carefully and stored in the proper condition. Especially, moderate to high concentrated TCA solution must be treated by well-trained persons. A 46-year-old woman visited a private clinic for removal of fine wrinkles around the lip. She was refered to our department because of acute upper lip coagulation necrosis which was caused by injection of 35% TCA solution mistaken for lidocaine, which was supposed to be used for anesthesia. At her arrival, cental half of upper lip showed severe coagulation necrosis. The lesion was well discriminated in a few days, then debridement and immediate reconstruction was done using an Abbe flap. Chemical peeling is a relatively effective procedure for improvement of aging skin lesion in a lower cost with a short time operation, if the practitioner has much experience and optimal indication is properly selected. But not so as, side effect and complication may be often ocurred in a mistake and as a result irreversible scars are remained. We experienced a rare case of upper lip necrosis which was caused by TCA injection mistaked for lidocaine in a private clinic and so, We report this case with the results of experiment of rabbit model which was observation of macroscopic and microscopic changes of the abdominal skin of the rabbit injected with serially diluted TCA solution.
Acetic Acid ; Aging ; Anesthesia ; Caustics ; Cicatrix ; Debridement ; Female ; Freezing ; Humans ; Lidocaine ; Lip* ; Middle Aged ; Mucous Membrane ; Necrosis* ; Odors ; Phenol ; Pigmentation ; Skin ; Trichloroacetic Acid

BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

No abstract available.
Mycobacterium tuberculosis* ; Mycobacterium*

PURPOSE: To determine the efficacy of CarnitilR (acetylcarnitine, Hanmi, Korea) therapy in idiopathic oligoasthenospermic men. MATERIALS AND METHODS: Forty-four subfertile men with abnormal semen parameters were treated between March, 2003 and March, 2004 with 3 g of CarnitilR daily for 3 months. Changes in semen parameters were evaluated 3 months after this therapy. RESULTS: The mean age was 34.2 years and the mean follow-up duration was 3.7 months. In asthenospemic patients (n=28), semen analysis before and after CarnitilR treatment showed an increase in volume (2.64+/-1.65 ml vs. 3.10+/-1.60 ml), motility (35.1+/-17.7% vs. 45.9+/-20.4%) and viability (51.4+/-20.3% vs. 59.3+/-13.6%) respectively. In oligoasthenospermic patients (n=16), semen analysis before and after CarnitilR treatment showed an increase in sperm count (10.7+/-54.4 million/ml vs. 38.4+/-32.5 million/ml) respectively. CONCLUSIONS: These results suggested that in idiopathic oligoasthenospermic men the empirical medical therapy with acetylcarnitine may be considered as primary treatment.
Acetylcarnitine* ; Carnitine ; Follow-Up Studies ; Humans ; Infertility, Male ; Male ; Semen ; Semen Analysis ; Sperm Count

The study was undertaken to asses the changes in the size and densities of intracranial hematomas by analyzingthe sequential CT examination of 23 patients ar Soon Chun Hyang College Hospital from July '80 to Aug. '81. Theresuls were as follows; 1. The high densities of hematoma were the cause of hematoma, hematoma locaiton, age andsex of patients, and initial hematoma size. 3. The CT findings that indicate complete absorption of hematomas werenormalization of mass effect, not diappearence of hematoma densities. 4. In intracerebral hematoma, the highdensity of hematoma reduced it's density and mass effect about 4-6 weeks duration. 5. In subdural hematoma, about7 weeks after head trauma, the CT findings were normalized.
Absorption ; Craniocerebral Trauma ; Equidae ; Hematoma ; Hematoma, Subdural ; Humans

The management of skin and soft tissue defects on the buttock, perineum and lower abdomen has been improved through the development of myocutaneous flap. However, sacrifice of the deep muscles causes some problems such as intraoperative bleeding and functional disabilities of donor sites. And we can not also control the volume of the flap for the skin reliability of myocutaneous flaps. To overcome these disadvantages, we tried perforator-based myocutaneous island flaps for the reconstruction of the sacral, ischial sores or deep wounds of the perineum and lower abdomen. During the dissection of the flap, we could control the volume and shape of the flap exactly depending on the perforators. Clinically, total of 14 cases were treated with 10 parasacral perforator-based myocutaneous island flaps and 4 perforator-based extended myocutaneous island flaps. Parasacral flap is based on the parasacral perforators along the lateral sacral border and, the degree of containing muscles can be easily decided according to the depth of wound. In the cases of the extended myocutaneous flaps, we could design the perforator-based skin flap on the tip of myocutaneous island flap and appropriate volume of skin falp was obtained with the wide arc of rotation. Finally, the donor defect could be closed primarily and there was no significant sequela. There perforator-based myocutaneous island flaps require no significant sacrifice of the muscles and can be easily dissected and applied with the appropriate volumes for the reconstruction of the defect on the buttocks, perineum and lower abdomen.
Abdomen ; Buttocks ; Hemorrhage ; Humans ; Muscles ; Myocutaneous Flap ; Perineum ; Skin ; Surgical Flaps ; Tissue Donors ; Wounds and Injuries*

The reconstruction of pressure sore is often complicated problem due to underlying disease and general condition of the patients. Sometimes, it is too radical to use the muscle or musculocutaneous flap for the patients who has severe systemic disease and can not withstand the lengthy operation or the patients who already recovered from paraplegic condition and has no risk recurrence. To get over these problems, we recently have used the parasacral perforator-based island skin flaps for the sacral pressure sores. This flap is based on the axial pattern perforators originating from the internal pudendal artery and lateral sacarl artery. We performed this operation for 11 sacral sores with reasonable results. There was no significant complication, and duration of operation was relatively short and blood loss was a little. We concluded that this flap was useful for the patient with sacral pressure sore who could be categorized nontraumatic nonparaplegic group(NTNP group) or nontraumatic paraplegic group(NTP group). But this island flap has drawback, which is elimination of sensory nerve within the flap.
Arteries ; Humans ; Myocutaneous Flap ; Pressure Ulcer* ; Recurrence ; Skin*

OBJECTIVE: This study was performed to determine the relations of glycosylated hemoglobin (HbA1c) and parameters of nerve conduction study (NCS) in diabetic peripheral polyneuropathy patients. METHOD: Prospectively, total 40 patients with non-insulin dependent diabetes mellitus were included in the study. NCS was performed on median, ulnar, posterior tibial, deep peroneal, superficial peroneal, and sural nerves. Distal latency and conduction velocity (CV) of compound muscle action potential (CMAP), distal latency and amplitude of sensory nerve action potential (SNAP) were used as parameters of NCS. Multiple linear regression analysis were used to analyze the relations of HbA1c and parameters of NCS, after adjustment for age, height, weight, and disease duration of diabetes mellitus. RESULTS: HbA1c level had an inverse relation to CV of median motor nerve (beta= 1.272, p<0.01), ulnar motor nerve (beta= 1.287, p<0.01), posterior tibial nerve (beta= 0.982, p<0.05), and deep peroneal nerve (beta= 1.449, p<0.05). CONCLUSION: This study indicates that HbA1c level was inversely related to motor nerve CV, and that sustained hyperglycemia may be involved in demyelination of motor nerves. Analysis of motor nerve CV related to HbA1c is expected to be useful in the follow-up or efficacy study of diabetes mellitus neuropathy as baseline data.
Action Potentials ; Demyelinating Diseases ; Diabetes Mellitus ; Hemoglobin A, Glycosylated* ; Humans ; Hyperglycemia ; Linear Models ; Neural Conduction* ; Peroneal Nerve ; Polyneuropathies* ; Prospective Studies ; Sural Nerve ; Tibial Nerve

Invasive fungal sinusitis is common in immunodeficiency patients and can spread into the orbit or intracranial cavity. The Onodi cell, which is one of the anatomical variations of the ethmoid sinus, refers to the space that has been pneumatized superolateral to the sphenoid sinus. We experienced a case of invasive fungal sinusitis that caused vision loss by invading the Onodi cells. Endoscopic sinus surgery and antifungal treatment successfully recovered the patient’s vision and we herein report on the case with a review of the literature.