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*

From retrospective review of 111 tibial fractures treated by interlocking intramedullary nailing, 38 operative errors in 28 cases(25%) were included in this study. The errors were classified into two categories. The first category included eighteen errors that related to fracture reduction; nine angular malalignments, four failures in closed nailing to open the fracture site, two peroneal nerve palsies, two shortenings of tibial length(more than 1cm), and one rotational malalignment. The second category comprised twenty errors that related to the nailing itself; eight protrusions of proximal nail tip, five overdistractions of fracture gap (more than 3mm), four additional fragmentations, two mistakes in interlocking screw insertion, and one ankle joint injury by the distal nail tip. Functional results of those 28 cases at the last follow-up(average, 17.5 months; range, 9 to 29 months) were excellent or good in only 60.8 per cent, while the control group treated by adequate operative technique showed excellent or good results in 92.8 per cent.
Ankle Joint ; Fracture Fixation, Intramedullary ; Paralysis ; Peroneal Nerve ; Retrospective Studies ; Tibial Fractures

No abstract available.
Cystadenoma*

No abstract available.
Cystadenoma*

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantations for the treatment of primary acquired nasolacrimal duct obstruction, and to determine the effects of various surgical procedures, including stent removal, in subsequent nasolacrimal duct obstruction. METHODS: This study included 15 patients who had nasolacrimal polyurethane implantations for the treatment of primary acquired nasolacrimal duct obstruction. Occluded stents were removed either by nasal endoscopy or during dacryocystorhinostomy (DCR). Cultures and biopsies were performed on the removed stents, and the results of the secondary DCR were analyzed for a 6-month follow-up period. RESULTS: During stent removal surgery, various degrees of chronic inflammatory reaction and fibrous tissue formation were detected in the lacrimal sac and nasolacrimal duct. Formations of granuloma and fibrous tissue were found in 15 eyes, and culture-positive reaction were found in nine of the 15 eyes. Conventional dacryocystorhinostomy surgery was performed in nine of the 15 eyes and a silicone tube was located at the canaliculi. Subjective and objective outcome were favorable in 13 of the 15 eyes. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low. This may result from a chronic inflammatroy reaction. Despite the low success rate of nasolacrimal polyurethane stent implantation, the success rate of endonasal DCR as a subsequent surgery is favorable.
Treatment Outcome ; *Stents ; Retrospective Studies ; Recurrence ; Prosthesis Implantation/*instrumentation ; *Polyurethanes ; Middle Aged ; Male ; Lacrimal Duct Obstruction/*pathology/surgery ; Humans ; Follow-Up Studies ; Female ; Device Removal ; Dacryocystorhinostomy/*methods ; Aged ; Adult

BACKGROUND: Rhabdomyolysis is a serious and potentially lethal condition that can develop from a variety of nontraumatic causes. Recently, there have been several reports about rhabdomyolysis which developed after alcohol abuse, drug intoxication, or vigorous exercise, but no report about all spectrums of nontraumatic rhadomyolyis in Korea. So we undertook this study to evaluate the clinical characteristics and course of nontraumatic rhabdomyolysis in a single medical center. METHODS: Several clinical and laboratory data were collected and analyzed in 68 patients with nontraumatic rhabdomyolyis from January 2002 to December 2003. RESULTS: The patients consisted of 58 males and 10 females with mean age of 48.0 +/- 16.3 years. The etiologic factors of nontraumatic rhabdomyolysis were as follows: 21 cases of alcohol abuse (30.9%), 13 cases of muscle ischemia (19%), 9 cases of shock (13%), 7 cases of infection, 6 cases of drug intoxication, 3 cases of seizure, 2 cases of malignant hyperthermia, 2 cases of diabetic ketoacidosis, 1 case of vigorous exercise, 1 case of CO poisoning, 1 case of hypophosphatemia, and 2 cases of unknown causes. Among the 68 patients, forty four patients (64%) developed acute renal failure and seventeen patients (25%) died of sepsis, acute respiratory distress syndrome, pulmonary edema or underlying diseases exacerbation. Among the 44 patients in acute renal failure, eighteen patients (41%) had oliguria during follow-up period. Thirteen patients of them needed dialysis and sixteen patients of them (36.4%) died. Another developed complications were hepatic dysfunction (34%), disseminated intravascular coagulation (28%), hypocalcemia (28%), acute respiratory distress syndrome (26%), pneumonia (22%), pulmonary edema (21%), hyperphosphatemia (7%) and hyperkalemia (4%). CONCLUSION: Nontraumatic rhabdomyolysis with acute renal failure is a serious and potentially lethal condition. Optimal treatment depends on early recognition and intervention. A high clinical suspicion for the occurrence of rhabdomyolysis in the nontraumatic conditions can lead to quicker recognition and better patient care.
Acute Kidney Injury ; Alcoholism ; Diabetic Ketoacidosis ; Dialysis ; Disseminated Intravascular Coagulation ; Female ; Follow-Up Studies ; Humans ; Hyperkalemia ; Hyperphosphatemia ; Hypocalcemia ; Hypophosphatemia ; Ischemia ; Korea ; Male ; Malignant Hyperthermia ; Oliguria ; Patient Care ; Pneumonia ; Poisoning ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult ; Rhabdomyolysis ; Seizures ; Sepsis ; Shock

This study was done on a case of chronic otitis media in both ears of a 47-year-old woman who received tympanization in the left middle ear in a local hospital three years ago. Ossiculoplasty was not tried in this case due to fixation of the stapes. However, conductive hearing loss of the left ear continued after tympanization, necessitating middle ear exploration. After the exposure of middle ear cavity, we found the absence of malleus and incus, and the fixation of stapes. Stapedectomy was carried out and total ossicular replacement prosthesis was also performed for the protection of the oval window by using perichondrium, cartilage and fascia. Postoperative bone conduction showed improvement of 15 dB, and air conduction showed improvement of 22 dB. After the operation, an average air-bone gap was improved within 10 dB. We experienced good hearing improvement without significant complications during the follow up period.
Bone Conduction ; Cartilage ; Ear ; Ear, Middle ; Fascia ; Female ; Follow-Up Studies ; Hearing ; Hearing Loss, Conductive ; Humans ; Incus* ; Malleus* ; Middle Aged ; Ossicular Prosthesis* ; Ossicular Replacement* ; Otitis Media ; Stapes Surgery* ; Stapes*

PURPOSE: It was well known that transforming growth factor (TGF)-beta1 plays a pivotal role in interstitial fibrosis and loss of podocyte. We explored the effects of exogenous administration of TGF-beta1 latency-associated peptide (LAP) in a model of renal fibrosis induced by unilateral ureteral obstruction (UUO) and examined whether TGF-beta1 LAP can inhibit apoptosis of podocyte. METHODS: Twenty four male BALB/c mice were unilaterally obstructed of proximal ureters by ligation. Half of the mice with operation and half of 8 control were administered recombinant human LAP intraperitoneally. One to three mice per group were euthanized on days 3, 7, 14, and 21 after operation for observation of renal fibrosis and apoptosis of podocyte. RESULTS: Interstitial fibrosis was less severe in LAP-treated group. Obstructed kidneys from LAP- untreated mice had more glomerular apoptotic podocytes (TUNEL assay) compared to LAP-treated mice at day 7, 14, and 21 after operation. CONCLUSION: Intraperitoneal administration of TGF-beta1 LAP prevents the loss of podocyte & renal damage partially up to day 14 after operation.
Animals ; Apoptosis ; Fibrosis ; Humans ; Kidney ; Ligation ; Male ; Mice ; Podocytes ; Transforming Growth Factor beta1 ; Transforming Growth Factors ; Ureter ; Ureteral Obstruction

Rapamycin, a macrocyclic lactone, is effective in reducing the incidence of acute rejection after renal transplantation. The inhibitory effects of rapamycin on lymphocyte proliferation and the molecular mechanisms that were involved have been described. However, its effects on glomerular mesangial cells have not been clearly understood, and here, we examined the effect of rapamycin on platelet-derived growth factor (PDGF) - induced extracellular matrix synthesis as well as cell proliferation in mesangial cells. Rat mesangial cells were isolated from the glomeruli of Sprague-Dawley rats and cultured with Dulbecco's modified Eagles medium containing 20% fetal bovine serum. Different concentrations of rapamycin were administered 1 hour before the addition of 10 ng/ml of PDGF into growth arrested and synchronized cells. Cell proliferation was assessed by [3H]thymidine incorporation, total collagen synthesis by [3H]proline incorporation, and fibronectin secretion into the medium by Western blot analysis. In the mesangial cells, PDGF increased cell proliferation by 4.6-fold, total collagen synthesis by 1.8-fold, and fibronectin secretion by 3.2-fold. Rapamycin above 10 nM significantly inhibited PDGF-induced proliferation and collagen synthesis, but the treatment of rapamycin up to 1micrometer did not show any significant effects on PDGF-induced fibronectin secretion. These inhibitory effects of rapamycin on PDGF-induced mesangial cell proliferation and collagen synthesis reflect the potential value of rapamycin in the prevention and treatment of glomerulosclerosis in patients with chronic allograft nephropathy.
Animals ; Cells, Cultured ; Collagen/*antagonists & inhibitors/biosynthesis ; Fibronectins/*biosynthesis ; Glomerular Mesangium/cytology/drug effects/*metabolism ; Immunosuppressive Agents/*pharmacology ; Male ; Platelet-Derived Growth Factor/*pharmacology ; Rats ; Rats, Sprague-Dawley ; Research Support, Non-U.S. Gov't ; Sirolimus/*pharmacology

No abstract available.
Bone Marrow Transplantation* ; Bone Marrow* ; Graft vs Host Disease* ; Humans ; Meningoencephalitis* ; Streptococcus pneumoniae* ; Streptococcus*