Deep skin and soft tissue defects with exposed bone and tendon is difficult to treat, because skin graft rarely survives and flap surgery is sacrifice of donor site. Since "Stage I" membrane was developed by Yannas and Bruke in 1980, numerous kinds of artificial skin have been developed. The adaptability of "Terudermis", developed by the Terumo Co., as an artificial skin composed of sponge made of a fibrillar atelocollagen and a heat-denatured atelocollagen, was clinically evaluated on application to 13 cases presenting deep skin and soft tissue defect with exposed bones and tendons from October 1997 to march 1998. Terudermis has the advantage of allowing early incorporation of fibroblasts and capillaries into its collagen sponge due to very weak dehydrothermal cross-linking. Before Terudermis graft, several days of wet dressing and debridement were required to prepare healthy well-vascularized bed because Terudermis was weak on unsanitary wounds. After bed preparation, Terudermis was grafted like usual skin graft. Tie-over bolster dressing or compressive dressing was used case by case. The dressing was opened 2~3 days after Terudermis grafting. Wet dressing was done daily until the skin graft was done. Autologous skin graft was done 2-3 weeks after Terudermis graft. Our clinical results indicated that Terudermis was beneficial in treating 77% of our patients. Through the use of this new method, treatment of severe skin and soft tissue defects that are usually treated by musculocutaneous or other conventional skin flaps can be replaced by Terudermis as an new artificial dermis.
Bandages ; Capillaries ; Collagen ; Debridement ; Dermis ; Fibroblasts ; Humans ; Membranes ; Porifera ; Skin ; Skin, Artificial ; Tendons ; Tissue Donors ; Transplants ; Wounds and Injuries*

In order to assess the effects of diazepam and meperidine as premedication for upper gastrointestinal endoscopy, eighty eight patients undergone an elective upper gastrointestinal endoscopy were studied. Studied patients were divided into two groups; one group was premedicated with buscopan and stropine(group I), and the other group was premedicated with diazepam and meperidien (group II). The results obtained were summarized as follows; 1) 83.0% of the group II (44/53) did not eomplain any discomfort by the procedure, but only 23.9% (8/35) of the group I showed no discopmort. The difference between two groups is statiatieally significant (p<0.005). 2) In 41 patients with previous experience of endoscopy, 22 patients from 27 of the graup Il(81.5%) did not feel any discomfort but it wes only 3 patients among 14 of the group I (21.4%) who did not feel discomfart (p<0,005). 3) In 47 patients without previous experience of endoscopy, 23 patients from 26 of the group II (88. 5%) did not show discomfort but it way only 5 patients among 21 of the group I (23.7%) (p<0.005). 4) In the patients with previous experience of endoscopy, 21 patients among 27 of the group II (77. 8%) felt better than that of the previous experience but it was only 3 patients among 14 of the group I (21.4%) (p<0.005). From the above results, we would emphasize that it is more effective to use diazepam and, meperidien as premendication for the gastrointestinal endoscopic procedure since it removes pstients apprehension rendering them a good cooperation with very minimal side effects,
Butylscopolammonium Bromide ; Diazepam ; Endoscopy ; Endoscopy, Gastrointestinal ; Humans ; Meperidine ; Premedication*

PURPOSE: Even in a small levator resection for blepharoptosis, 10-13mm of Muller's muscle and levator aponeurosis is resected. To solve the problem, Muller's muscle was detached from the superior tarsal border and conjunctiva, and the muscle with overlying levator aponeurosis was advanced on the upper tarsus as a composite flap. The purpose of this study is to evaluate the effectiveness of the Muller's muscle-levator aponeurosis complex advancement technique for the correction of blepharoptosis. METHODS: From 2003 to 2008, 107 patients(183 eyes) underwent the advancement procedure of the Muller's muscle-levator aponeurosis composite flap for blepharoptosis. The advanced composite flap was fixed 3 mm below the superior tarsal border and 2-3mm of distal flap stump was left after trimming up to 5mm. The results of the operations were evaluated. RESULTS: The mean age of the patients was 35.2 years and 83 patients(145 eyes) were followed up for a mean of 16.7 months. 128 eyes(88.3%) showed a normal level of upper eyelid margin(MRD1 4.1-5.0mm) or less than 1mm ptosis(MRD1 3.1-4.0mm). 10 eyes(6.9%) showed 1-2mm ptosis(MRD1 2.1-3.0mm). 7 eyes(4.8%) showed more than 2mm ptosis which required secondary correction. About 80% of the 183 eyes needed no trimming of the flap stump with 5-6mm of composite flap advancement and 20% had about 3mm of the flap stump trimmed with 8-9mm of composite flap advancement (shortening of the levator complex). CONCLUSION: Muller's muscle-levator aponeurosis complex advancement technique offers several advantages: There is no, or minimal, sacrifice of the normally functioning Muller's muscle; it is more physiological; it is reproducible and it is predictable-with gratifying results for blepharoptosis.
Animals ; Ankle ; Blepharoptosis ; Conjunctiva ; Eye ; Eyelids ; Humans ; Muscles

PURPOSE: Single hair transplantation for eyebrow loss has been considered as a good method of achieving natural appearance of eyebrow. To date, however, no study has reported the survival rate following single hair transplantation for cicatricial eyebrow alopecia. METHODS: We performed single hair transplantation using Choi hair transplanter for 49 cases of scarring eyebrow loss from March 2003 to March 2006. Of these cases, 33 could be under a follow-up postoperatively for more than seven months. These 33 cases comprised 20 men and 13 women. Mean follow-up period was 12 months (7-36 months). In 17 patients(51.5%), 100 to 200 hairs were unilaterally transplanted. RESULTS: Following initial hair transplantation, the surgical outcome was excellent in 11 cases(33.3%), good in 12 cases(36.4%), fair or poor in the remaining ten cases(30.3%). All procedures were done under intravenous sedation and local or regional block anesthesia. It took about one and a half hours for us to transplant 200 hairs. The shape of eyebrow was aesthetically acceptable with a good direction and an ideal inclination of hairs. No patients developed notable complications, while 30 percent had a low survival rate. CONCLUSION: Single hair transplantation using Choi hair transplanter is a safe, effective surgical method for scarring eyebrow loss.
Alopecia* ; Anesthesia ; Cicatrix ; Eyebrows* ; Female ; Follow-Up Studies ; Hair* ; Humans ; Male ; Survival Rate

No abstract available.
Listeria* ; Meningitis, Listeria* ; Transplantation*

No abstract available.
Humans ; Mesenteric Veins* ; Nephrotic Syndrome* ; Thrombosis*

PURPOSE: Closed reduction is most common treatment method for nasal bone fracture but it requires secondary correction operation commonly. For preventing secondary revision, we applied ultrasonography during closed reduction of nasal bone fracture and examined the result of operation. METHODS: 80 patients were sorted into 2 groups, ultrasound-guided closed reduction group(n=40) and manual closed reduction group(n=40). We classified the unilateral fracture involving lower 1/2 of nasal bone into type I, the bilateral fracture involving lower 1/2 of nasal bone into type III and the fracture of upper 1/2 of nasal bone into type III. The occurrence rate of overcorrection and undercorrection were evaluated by comparing preoperative and postoperative MDCT(Multi Direction Computed Tomography) RESULTS: In manual closed reduction group, overcorrection were found in 4 patients and undercorrection were found in 3 patients. In ultrasound-guided closed reduction group, overcorrection was not observed and undercorrection was observed in 2 patients. CONCLUSION: Intraoperative ultrasound evaluation of nasal bone fracture resulted in reduced occurrence rate of secondary nasal deformities, showed easier detection of the fractured site and have superiority upon simple physical examination or simple x-ray.
Congenital Abnormalities ; Humans ; Nasal Bone ; Physical Examination

Proliferating trichilemmal cyst(proliferating trchilemmal tumor, PTC) most commonly occurs in the scalp and is generally benign. Malignant transformation of PTC is rare, and the appearance of a spindle cell(sarcomatoid) carcinoma is extremely rare. The authors experienced a case of malignant proliferating trchilemmal tumor with spindle cell carcinoma on the scalp in a 41-year-old male. The tumor was widely resected and covered with split thickness skin graft after Terudermis(R) graft. Imaging studies and fine needle aspiration cytology showed no regional lymph node involvement or distant matastasis.
Adult ; Biopsy, Fine-Needle ; Humans ; Lymph Nodes ; Male ; Scalp ; Skin ; Transplants

Hypoxia-inducible factor-1 (HIF-1) is composed of HIF-1alpha and HIF-1beta, and is a master regulator of oxygen homeostasis, playing critical roles in physiological and pathological processes. Normally, the formation and transcriptional activity of HIF-1 depend on the amount of HIF-1alpha, and the expression of HIF-1alpha is tightly controlled by the cellular oxygen tension. Recent progress in the study of its regulation mechanism provided clues as to how HIF-1alpha is regulated by oxygen. It appears that HIF-1alpha is not regulated only by the oxygen tension, but also by various other stimuli, such as transition metals, nitric oxide, reactive oxygen species, growth factors, and mechanical stresses. In this review, we summarize the oxygen-dependent and -independent regulation of HIF-1alpha, and the respective physiological and pathological meanings.
Animals ; Growth Substances/metabolism ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; Molecular Structure ; Nitric Oxide/metabolism ; Oxygen/*metabolism ; Reactive Oxygen Species/metabolism ; Stress, Mechanical ; Transcription Factors/chemistry/genetics/*metabolism ; Transition Elements/metabolism

BACKGROUND: Head injury is one of the most common causes of emergency department visits and hospital admission in the pediatric populations, and most injuries are mild. In mild head injury, grading of severity and decision of hospital admission are difficult in the emergency department. Recent studies have suggested that patients with a normal head CT scan and neurologic exam following head injury can be safely discharged from the emergency department. However, previous studies have relied on incomplete patient follow-up and been limited for the most part to adult population. So we performed this study to assess clinical course and the incidence of significant CNS sequelae in children with a normal head CT scan and no focal neurologic sign after mild head injuries during hospital admission and follow-up for 1 month. METHODS: We reviewal the records of children(n=209) admitted to the department of emergency medicine with closed head injuries from Jan. 1, 1996 to Dec. 31, 1996, who's initial Glasgow Coma Scale was 13 to 15, and have no focal neurologic sign and a normal head CT scan. RESULT: 209 patients were studied with a mean age of 6.8(range 3 months to 15years), and 66.5% were male. The most common mechanisms of injury were pedestrian T.A(50.2%) and fall(11.5%). Patients had a mean Glasgow coma scale of 14.8 and mean Abbreviated Injury Score of 1.3. Patients had clinical symptoms of headache(49.3%), vomiting(44.5%), loss of consciousness(LOC)(29.6%), amnesia(10.0%), sleepiness(8.6%), irritability(8.6%), confusion(2.9%) and seizure(1.9%). The mean duration of admission was 4.3 days(range: 6 hours-20 days) and the mean duration of symptom was 36.4 hours. No child developed significant CNS sequelae during hospital admission. However, during hospital admission, aye children(all were preschooler) had psychologic complication ; one child developed post-traumatic stress disorder requiring psychologic treatment for 3 months. Three children developed enuresis and two children developed night terror. During 1 month fallow-up, one child developed a symptomatic hemorrhagic contusion 5 days after the head injury, not requiring neurosurgical treatment. CONCLUSION: Among children with an initial Glasgow Coma Scale of 13 to 15, a normal head CT scan and no focal neurologic sign after mild head injuries, delayed intracranial sequelae are extremely uncommon. So these patient may be discharged home with parental supervision and education for dose observation.
Adult ; Child* ; Contusions ; Craniocerebral Trauma* ; Education ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Enuresis ; Follow-Up Studies ; Glasgow Coma Scale ; Head Injuries, Closed ; Head* ; Humans ; Incidence ; Male ; Neurologic Manifestations ; Organization and Administration ; Parents ; Stress Disorders, Post-Traumatic ; Tomography, X-Ray Computed