The clinical applications of free have been extended tremendously in head and neck reconstruction. In a nine-year period, 92 microvascular free flaps were performed to repair the defects following major head and neck ablative surgery. Twenty-one transverse rectus abdominis myocutaneous flaps, 18 radial foream flaps, 15 latissimus dorsi muscle flaps, 12 jejunal flaps, 8 fibular osteocutaneous flaps, 6 rectus abdominis muscle flaps, 6 iliac osteomyocutaneous flaps, 2 groin fasciocutaneous flaps, 1 scapular fasciocutaneous flap, 1 parascapular osteocutaneous flap, 1 tensor fascia lata muscle flap and 1 serratus anterior muscle flap were used for reconstruction. Twenty-five maxillary defects including the orbit or skull base, 16 pharyngoesophageal defects, 15 intraoral defects, 15 mandibular defects, 13 scalp defects, 1 cervical region and 7 other facial region were covered with various free flaps. The overall success rate of the flaps was 95.6%. The complications included total flap loss (3 cases), partial flap loss (1 case), recurrence of primary tumors (15 cases), cerebrospinal fluid leakage (3 cases), fistula formation (3 cases) and infection (5 cases). Superficial temporal artery, facial artery, superior thyroidal artery, lingual artery, occipital artery, transverse cervical artery were commonly used recipient arteries and 7 cases of vein grafts were used if indicated. End to end anastomosis was performed in 84 cases and end to side anastomosis in 8 cases. The average follow-up period was 42 months, ranging from 6 months to 8 years. One patent died during postoperative intensive care due to sepsis and 19 patients died because of recurrence of tumors and underlying medical diseases during the follow-up period. Although free flaps may appear to be riskier than traditional forms of reconstruction, they offer the surgeon a greater spectrum of reconstructive options. Free flap reconstruction also improves the quality of life and minimizes the loss of function. Limitations of the use of free flaps result only from a lack of technical skills and specialized equipment.
Arteries ; Cerebrospinal Fluid ; Fascia Lata ; Fistula ; Follow-Up Studies ; Free Tissue Flaps* ; Groin ; Head* ; Humans ; Critical Care ; Myocutaneous Flap ; Neck* ; Orbit ; Quality of Life ; Rectus Abdominis ; Recurrence ; Scalp ; Sepsis ; Skull Base ; Superficial Back Muscles ; Temporal Arteries ; Thyroid Gland ; Transplants ; Veins

PURPOSE: This study aimed to investigate the impact of nursing professionalism on the nursing performance and retention intention among psychiatric mental health nurses. METHODS: As a descriptive correlational study, this study sampled 206 psychiatric mental health nurses in six hospitals in Seoul and Gyeonggi area through convenience sampling. Data were collected from March 2 to 31, 2009 using a self-report questionnaire. The collected data were analyzed using SPSS WIN 16.0. RESULTS: In the subscales of professionalism, the 'Sense of calling' had the highest mean score while the 'Professional organization' had the lowest mean score. A significant positive correlation was observed in nursing professionalism, nursing performance and retention intention. According to an analysis on the impact of each subscale of nursing professionalism on nursing performance and retention intention, the 'Sense of calling' and 'Autonomy' were the most significant predictor variable. CONCLUSION: The results confirmed that the improvement of psychiatric mental health nurses' professionalism increases their nursing performance and retention intention and the 'Sense of calling' and 'Autonomy' are critical prediction factors. It is necessary to come up with a strategy which strengthens nursing professionalism in order to improve psychiatric mental health nurses' performance and retention intention.
Humans ; Intention ; Mental Health ; Nursing Staff ; Professional Practice ; Surveys and Questionnaires ; Retention (Psychology)

BACKGROUNG AND OBJECTIVES: It was reported that low molecular weight heparin (LMWH) was more effective than unfractionated heparin in patients with acute coronary syndrome. Recent studies have shown that the pathophysiology of restenosis in stented lesions was different from those of nonstented lesions. Treatment strategies designed to limit cellular proliferation that were ineffective in nonstented lesions may be efficacious in reducing in-stent restenosis. This study was aimed to compare the clinical and angiographic results of LMWH (nadroparin) after coronary stenting with those of conventional ticlopidine regimen. MATERIALS AND METHODS: Patients were eligible for inclusion if they had angina and/or objective evidence of myocardial ischemia, and a significant (>50%) stenosis that was documented on a recent coronary angiogram. After stenting, prospective randomized comparison study was performed. Patients were randomly assigned to either nadroparin (200 IU/kg, sc, bid) or ticlopidine (250 mg bid) plus aspirin (200 mg qd) treatment groups. Repeat coronary angiography (KERN=*)was performed at 236+/-90days after stenting, and quantitative coronary angiographic analysis (QCA) was done. RESULTS: Intracoronary stent implantation was performed in eighty five lesions in eighty one patients (ticlopidine:40, nadroparin:41). There was no significant difference in any baseline clinical/angiographic variables between the two treatment groups. There were no subacute stent thrombosis, infarction and death in both groups. Six-month event-free survival was 36 (90%) in the ticlopidine group and 35 (85.4%) in the nadroparin group. Follow-up quantitative angiographic data such as late loss (1.35+/-0.70 vs 1.32+/-0.69), loss index (0.53+/-0.70 vs 0.56+/-0.23) and restenosis rate (36% vs 25.8%) were not different between ticlopidine and nadroparin groups. CONCLUSION: Effects of nadroparin were not different from those with ticlopidine therapy in the prevention of restenosis and subacute stent thorombosis after coronary stenting. Clinical outcomes between two strategies were similar. Low molecular weight heparin may be an alternative to ticlopidine in patients that ticlopidine cannot be administered because of severe adverse effects.
Acute Coronary Syndrome ; Aspirin ; Cell Proliferation ; Constriction, Pathologic ; Coronary Angiography ; Disease-Free Survival ; Follow-Up Studies ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Infarction ; Myocardial Ischemia ; Nadroparin* ; Prospective Studies ; Stents* ; Thrombosis ; Ticlopidine*

Our objective is to describe the CT features of exophytic hepatic tumors those may pose a diagnostic challenge because of the uncertainty of tumor origin. The beak sign and the feeding artery of a tumor are useful diagnostic indicators of exophytic hepatic tumors. Two- or three-dimensional reformation images are also helpful for diagnosis. The CT features of exophytic hepatic tumors are similar to those of the usual intrahepatic tumors except for their location.
Contrast Media ; Diagnosis, Differential ; Humans ; Liver Neoplasms/pathology/*radiography ; Radiographic Image Interpretation, Computer-Assisted ; *Tomography, X-Ray Computed

OBJECTIVES: The present study assessed the effect of trazodone on the cerebral hemodynamics of male Sprague-Dawley rats. METHOD: The changes of regional cerebral blood flow(rCBF) and pill arterial diameter were measured by laser-Doppler flowmetry and by a videomicroscopy, respectively. The changes in vascular tone and intracellular free Ca2+ concentration ([Ca2+]i) of isolated basilar artery were simultaneously measured using a small vessel myograph and a cation measurement system, respectively. RESULT: Both the rCBF and the pill arterial diameter were dose-dependently decreased by systemic administration of trazodone(0.3-10 mg/kg, i.v.), but not by topical application of trazodone(10-300 micrometer). Pretreatment with 5-HT(2A/2C) receptor antagonist(ketanserin or ritanserin, 1 mg/kg, i.v., respectively) significantly blocked the changes in rCBF induced by trazodone. m-Chlorophenylpiperazine(mCPP ; 0.1-3 mg/kg, i.v. or 5-500 micrometer topical), a major active metabolite of trazodone, also dose-dependently decreased the rCBF as well as the pial arterial diameter. The mCPP-induced decreases in rCBF were significantly blocked by ketanserin. Pretreatment with itraconazole(1 mg/kg, p.o.), a selective inhibitor of CYP3A4, a subfamily of cytochrome P450, markedly attenuated the trazodone-induced changes in rCBF. In an isolated rat basilar arterial strip loaded with fura-2/AM, mCPP(5-500 micrometer caused a vasoconstriction in association with increases in [Ca2+]i, in a concentration-dependent manner. Pretreatment with 1 micrometerketanserin strongly blocked the effects of mCPP on the vascular tone as well as on the [Ca2+]i, of rat basilar artery. CONCLUSION: These results suggest that trazodone decreases rCBF through stimulation of 5-HT(2A/2C) receptors by its active metabolite, mCPP.
Animals ; Basilar Artery ; Cytochrome P-450 Enzyme System ; Hemodynamics* ; Humans ; Ketanserin ; Laser-Doppler Flowmetry ; Male ; Microscopy, Video ; Rats* ; Rats, Sprague-Dawley ; Ritanserin ; Trazodone* ; Vasoconstriction

Here we describe a case of Twiddler's syndrome in a patient with an implanted cardioverter-defibrillator who tinkered with the device, shifting it to a vertical position and causing her skin to protrude in various locations. Fluoroscopy was used to determine what direction the device was rotating in during specific body postures and physical activities. Inappropriate shocks were delivered whenever the patient pushed the device down toward her sternum. The syndrome did not recur following training of the patient in a lead-revision procedure that involved shifting the device down vertically toward her lateral side with her hands.
Defibrillators ; Fluoroscopy ; Hand ; Humans ; Motor Activity ; Posture ; Shock ; Skin ; Sternum

Sjogren's syndrome is a chronic,slowly progressive,autoimmune disease in which the exocrine glands are damaged by lymphocytic infiltration,resulting in xerostomia and xerophthalmia.Fever in patients with Sjogren's syndrome is rarely manifested with the exception of cases with complicated illness such as lymphoma.We experienced a 70-year-old male patient with Sjogren's syndrome who was presented with fever of unknown origin.Despite of thorough investigation,other diseases to cause fever could not be found.Fever and other clinical features were improved with empirical steroid therapy.
Aged ; Exocrine Glands ; Fever of Unknown Origin* ; Fever* ; Humans ; Male ; Sjogren's Syndrome ; Xerostomia

No abstract available.
Esophageal Perforation*

OBJECTIVES: It was aimed to observe the regional cerebral blood flow (rCBF) response on methamphetamine challenge test in rats which were subjected to repeated administration of methamphetamine, and to investigate the mechanism(s) of changes in rCBF response in relation to the dopaminergic receptors and cyclic AMP. METHODS: Male Sprague-Dawley rats received daily injections of methamphetamine (0.3 mg/kg, i.p.) for 10 days, and were then allowed a 4-day drug-free period. Naive and methamphetamine-pretreated rats were challenged with topical application of methamphetamine on the surface of parietal cortex through a cranial window. The changes in rCBF were measured by laser-Doppler flowmetry. RESULTS: Acute topical application of methamphetamine dose-dependently increased rCBF with little effect on mean arterial blood pressure. The methamphetamine-induced increases in rCBF were significantly blocked by SCH23390, a D1-like receptor antagonist, but not by sulpiride, a D2-like receptor antagonist. Repeated administration of methamphetamine induced progressive augmentation of rCBF in response to the challenge of methamphetamine. Repeated administration of methamphetamine in combination with SKF38393, a D1-like receptor agonist, as well as with SCH23390 significantly attenuated the development of augmentation of rCBF response to methamphetamine. The augmentation of rCBF response was markedly inhibited by pretreatment with 2',3'-dideoxyadenosine, a specific adenylyl cyclase inhibitor, and Rp-cAMPS, a protein kinase A inhibitor, respectively. CONCLUSION: Based on these results, it is suggested that repeated administration of methamphetamine induces an augmentation of rCBF in response to the challenge of methamphetamine, and that D1-like receptor-mediated cyclic AMP plays a critical role in the development of augmentation of methamphetamine-induced rCBF response.
2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine ; Adenylyl Cyclases ; Animals ; Arterial Pressure ; Cyclic AMP ; Cyclic AMP-Dependent Protein Kinases ; Dideoxyadenosine ; Humans ; Laser-Doppler Flowmetry ; Male ; Methamphetamine* ; Rabeprazole ; Rats* ; Rats, Sprague-Dawley ; Sulpiride

Seckel syndrome is a rare autosomal recessive disease. The characteristic features of Seckel syndrome include Intrauterine and postnatal growth deficiency, severe microcephaly, and a bird-like head. General appearance of our patient was characterized by Pre- and postnatal growth retardation, microcephaly, large eye, and a beaked nose. The patient had mental retardation with CNS anomalies. The CNS anomalies seen in the patient included cerebral dysgenesis and cerebellar atrophy. So, we report the case of CNS anomalies in Seckel syndrome.
Animals ; Atrophy ; Beak ; Head ; Humans ; Intellectual Disability ; Microcephaly ; Nose