PURPOSE: To investigate involvement of chronic estrogen deficiency in impairment of relaxation response of the clitoral cavernous smooth muscle. MATERIALS AND METHODS: New Zealand white female rabbits were randomly divided control (sham operation, n=6) and experimental groups; 1) bilateral oophorectomy (n=8), 2) oophorectomy with estradiol replacement (n=7), 3) oophorectomy with flutamide treatment (n=6). All the rabbits were sacrificed 12 weeks after the operations. Blood levels of estradiol and lipid fractions were measured just before the operations and sacrifice. Clitoral cavernous strips were obtained to observe relaxation responses to endothelium-dependent and -independent vasodilators, and electrical field stimulation (ESF). RESULTS: The uterus weight and serum estradiol level decreased significantly (p<0.01) in the oophorectomy group compared with the baseline data. The serum levels of total cholesterol, triglyceride, and low density lipoprotein increased significantly (p<0.01) in the oophorectomy group. The relaxations of the clitoral strips to acetylcholine were significantly attenuated in the oophorectomy group compared with those of the control and estrogen replacement groups. However, sodium nitroprusside- and nonadrenergic noncholinergic-induced relaxations were not significantly different among the 4 groups. No significant histologic changes were noted in the clitoral tissues of the oophorectomy group. CONCLUSIONS: Chronic estrogen deficiency in the rabbits may cause impairment of endothelium-dependent relaxation of clitoral corpus cavernosal smooth muscles. Further studies are needed to determine whether the hypoesterogenemia itself and/or secondary hypercholesterolemia due to the chronic estrogen deficiency may result in the impairment.
Acetylcholine ; Cholesterol ; Estradiol ; Estrogen Replacement Therapy ; Estrogens ; Female ; Flutamide ; Humans ; Hypercholesterolemia ; Lipoproteins ; Muscle, Smooth* ; New Zealand ; Ovariectomy ; Rabbits ; Relaxation* ; Sodium ; Triglycerides ; Uterus ; Vasodilator Agents

Free neurovascular flap transfers have been widely used for restoration of discriminative sensibility and contour of the finger. The free neurovascular flaps from first web space of the foot is a good treatment option to achieve above two conditions. Fingertip reconstruction with a free toe pulp neurovascular flap, since it was described first in 1979, have been reported a lot. But in most cases. toe pulp flap used first dorsal metatarsal artery as a vascular pedicle. The authors, therefore, carried out four dissections on the cadavers to study first web space neurovascular anatomy for using the dorsal digital artery of the foot as a vascular pedicle. On the basis of the results of this cadaver dissection, we reconstructed posttraumatic soft tissue defect of the fingers with first and second toe pulp free flaps in nine patients from February 1999 to April 2000, and obtained adequate functional recovery as well as satisfactory aesthetic appearance. In our case, maximal flap was 2.5 x 2 cm in size, and the dorsal digital artery of the foot, subcutaneous vein and branch of the dorsal deep peroneal nerve were used as a neurovascular pedicle of the flap. All patients gradually recovered a discriminative sensibility, with static two-point discrimination test between 7 and 16mm and a moving two-point discrimination test between 6 and 13mm. The advantages of this free flap from toe(mainly second toe) are minimal donor site morbidity including arterial system, one-stage operation and shorter rehabilitation period. We consider that the free toe pulp flap using dorsal digital artery of the foot is a useful method for reconstruction of small finger soft tissue defect.
Arteries* ; Cadaver ; Discrimination (Psychology) ; Fingers* ; Foot ; Free Tissue Flaps ; Humans ; Metatarsal Bones ; Peroneal Nerve ; Rehabilitation ; Tissue Donors ; Toes* ; Veins

When soft tissue circular or elliptical pathologic lesions are located around the nasolabial fold, the most appropriate method is to make the excision parallel with the scar or along a natural wrinkle-crease. For this purpose, simple elliptical excision following primary closure is recommended. But when its long axis of elliptical defects is located vertically to the nasolabial fold, these will bring a bad aesthetic result after elliptical excision following primary closure due to long vertical straight scar to nasolabial fold. If soft tissue defect is larger, we should depend on the wide dissection for the closure of elliptical excised area. As a result, it is inevitable to make postoperative deformity due to tension around the eyelids, oral commissures, canthal fold, and alar nose. V-Y-S plasty was introduced by Algamaso in 1974 for closure of a round defect. It adopted some aspects of the double rotation flaps(or S-plasty) and some of the V-Y advancements. The authors applied from March 1998 to December 2000 to use single rotation flaps(or half-S plasty) and V-Y advancement for closure of a round defect, around nasolabial folds in 12 patients, named it half V-Y-S plasty, by modifying of Argamaso's V-Y-S plasty. We could obtain sufficient coverage of round defects and placement postoperative scar on the nasolabial fold and alar crease area using single V-Y-S plasty. Even in case of hypertrophic scars, we could obtain the same result and symmetric postoperative supralabium contour. The average soft tissue defect diameter was 1.9 cm (biggest one: 3.2 cm), and advanced gain of V-S advancement was 1.34 cm. As a result, we could obtain the final result more aesthetic and functional than that of straight line closure or other type of local flap. We described the experience of half V-Y-S plasty with a review of literature.
Axis, Cervical Vertebra ; Cicatrix ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Eyelids ; Humans ; Nasolabial Fold* ; Nose

PURPOSE: To evaluate functions of the elbow joint according to surgical approach, time to exercise, and type of fracture after surgical treatment for the intra-articular comminuted fracture of the distal humerus. MATERIALS AND METHODS: 27 patients with the intra-articular comminuted fractures of the distal humerus underwent surgery from March, 2000 to January, 2007. We investigated the surgical approach, time for union, time to exercise and age. We also evaluated postoperative functions of the elbow joint according to the flexion contracture, the range of motion and the Mayo elbow performance score. RESULTS: The average follow-up period was 37 months and the average time for union was 14 weeks. The average range of flexion was 115 degrees, the average flexion contracture was 10 degrees, and the Mayo elbow performance score with average value of 85 point showed good clinical results. There were no statistically significant differences in functions of the elbow joint according to the operative method and age. However, patients with early postoperative exercise within 6 days showed statistically better outcomes than patients with postoperative exercise after 7 days. Type C1, 2 fractures showed statistically better results than the type C3 fracture. CONCLUSION: Stable fixation and early exercise are required to prevent postoperative complications and restore functions of the elbow joint with an intra-articular comminuted fracture of the distal humerus.
Contracture ; Elbow ; Elbow Joint ; Follow-Up Studies ; Fractures, Comminuted ; Humans ; Humerus ; Intra-Articular Fractures ; Postoperative Complications ; Range of Motion, Articular

PURPOSE: We attempted to evaluate the diagnostic usefulness of the degree of perilesional edema around intracerebral hematoma in predicting the underlying cause. MATERIALS AND METHODS: This study included 54 patients with intracerebral hematoma for whom the underlying cause was confirmed by biopsy, radiological or clinical methods. Cases of subarachnoid hemorrhage, hemorrhagic transformation of cerebral infarction and intraventricular hemorrhage were excluded. The lesion size was defined as the average value of the longest axis and the axis perpendicular to this. The size of the perilesional edema was defined as the longest width of the edema. In all cases, the sizes of the lesion and edema were measured on the T2 weighted image. We defined the edema ratio as the edema size divided by the lesion size. RESULTS:23 cases were diagnosed as intracerebral hemorrhage due to neoplastic conditions, such as metastasis (n=17), glioblastoma (n=5), hemangioblastoma(n=1). 31 cases were caused by non-neoplastic conditions, such as spontaneous hypertensive hemorrhage (n=23), arteriovenous malformation (n=4), cavernous angioma (n=3), and moya-moya disease (n=1). In fourteen cases, which were confirmed as malignant intracerebral hemorrhage, the edema ratio was more than 100%. Of the other cases, only 8 were confirmed as malignant intracerebral hemorrhage. It was found that the larger the edema ratio, the more malignant the intracerebral hemorrhage, and this result was statistically significant (p<0.001). CONCLUSION: Measurement of perilesional edema and the intracerebral hematoma ratio may be useful in predicting the underlying causes.
Arteriovenous Malformations ; Axis, Cervical Vertebra ; Biopsy ; Cerebral Hemorrhage* ; Cerebral Infarction ; Edema* ; Glioblastoma ; Hemangioma, Cavernous ; Hematoma ; Hemorrhage ; Humans ; Moyamoya Disease ; Neoplasm Metastasis ; Subarachnoid Hemorrhage

BACKGROUND: Lipid emulsions have been used to treat various drug toxicities and for total parenteral nutrition therapy. Their usefulness has also been confirmed in patients with local anesthetic-induced cardiac toxicity. The purpose of this study was to measure the hemodynamic and composition effects of lipid emulsions and to elucidate the mechanism associated with changes in intracellular calcium levels in myocardiocytes. METHODS: We measured hemodynamic effects using a digital analysis system after Intralipid(R) and Lipofundin(R) MCT/LCT were infused into hearts hanging in a Langendorff perfusion system. We measured the effects of the lipid emulsions on intracellular calcium levels in H9c2 cells by confocal microscopy. RESULTS: Infusion of Lipofundin(R) MCT/LCT 20% (1 ml/kg) resulted in a significant increase in left ventricular systolic pressure compared to that after infusing modified Krebs-Henseleit solution (1 ml/kg) (P = 0.003, 95% confidence interval [CI], 2.4-12.5). Lipofundin(R) MCT/LCT 20% had a more positive inotropic effect than that of Intralipid(R) 20% (P = 0.009, 95% CI, 1.4-11.6). Both lipid emulsion treatments increased intracellular calcium levels. Lipofundin(R) MCT/LCT (0.01%) increased intracellular calcium level more than that of 0.01% Intralipid(R) (P < 0.05, 95% CI, 0.0-1.9). CONCLUSIONS: These two lipid emulsions had different inotropic effects depending on their triglyceride component. The inotropic effect of lipid emulsions could be related with intracellular calcium level.
Animals ; Blood Pressure* ; Calcium* ; Drug-Related Side Effects and Adverse Reactions ; Emulsions ; Heart* ; Hemodynamics ; Humans ; Microscopy, Confocal ; Myocardial Contraction ; Parenteral Nutrition, Total ; Perfusion ; Rats* ; Triglycerides

BACKGROUND: Body mass index is currently applied as the diagnostic standard of overweight and obesity, regardless of age. Percentage body fat ratio applies separate standards among different sex, but does not have separate standards for different age groups. Since body mass index and percentage body fat may differ according to age, we conducted this study to see if a separate standard for overweight and obesity is indeed necessary for different age groups. METHODS: We selected 2,190 subjects, who were the 10 percent picked randomly by computer, among 21,921 clients who had visited the St. Mary's Hospital's health promotion center in Seoul. Those diagnosed with diabetes, thyroid disease, renal failure, and tuberculosis were excluded, leaving 1,939 over the age of 20, as final subjects. Anthropometric measurements were done using electronic scales and height meters, while body composition was measured with a multi-frequency bioelectric impedance analysis (Inbody 3.0 Biospace, Seoul). The results of this study were shown in mean and standard deviation, and mean values according to ages were compared by Ancova test. RESULTS: In the case of adult men, percentage body fat increased with age. This was observed especially with subjects over 30 compared to subjects in their 20s, although not proven to be statistically significant. A decrease in fat free mass rather than increase in body fat mass was noted with aging. With adult women, percentage body fat increased markedly with subjects over 50, mainly due to increased body fat mass rather than decreased fat free mass. Subjects exceeding a body mass index of 25, which is the standard limit of body mass index for obesity, was 60th percentile for adult men, and 70~80th percentile for adult women. Percentage body fat in this case was 22.54% for men and 31.99~33.46% for women. CONCLUSION: Our study indicates that both men and women show changes in body mass index and fat free mass with aging. Hence, there are limitations to applying a universal standard for body mass index, regardless of age. We suggest that further studies on standards for adult obesity should be conducted based on specific Korean epidemiologic data.
Adipose Tissue* ; Adult ; Aging ; Body Composition ; Body Fat Distribution* ; Body Mass Index* ; Electric Impedance ; Female ; Health Promotion ; Humans ; Male ; Obesity ; Overweight ; Renal Insufficiency ; Seoul ; Thyroid Diseases ; Tuberculosis ; Weights and Measures

A reninoma is an uncommon, benign, renin-secreting juxtaglomerular cell tumor that causes secondary hypertension in young patients. This hypertension is treated by tumor resection. Except for increased levels of plasma renin and angiotensin I and II, the other physical and laboratory examinations and electrocardiographs were within normal limits upon admission of a 19-year-old woman with a reninoma. For percutaneous computed tomography-guided radiofrequency ablation, general anesthesia was induced by thiopental sodium and rocuronium bromide and maintained with servoflurane (2-4 vol%) and oxygen. The operation ended uneventfully in hemodynamic stability. However, the patient complained of dizziness while sitting 5 hours after the operation, and hypotension was diagnosed. After aggressive normal saline (1 L) infusion over 30 min, the hypotension was corrected and the patient recovered without any other surgical complications. Here, we report the anesthetic management of a patient who underwent percutaneous computed tomography-guided radiofrequency ablation for reninoma destruction, particularly focusing on postoperative hypotension.
Anesthesia, General ; Angiotensin I ; Catheter Ablation* ; Dizziness ; Electrocardiography ; Female ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Oxygen ; Plasma ; Renin ; Thiopental ; Young Adult

BACKGROUND: Intravenous lipid emulsion has been used to treat systemic toxicity of local anesthetics. The goals of this in vitro study were to determine the ability of two lipid emulsions (Intralipid(R) and Lipofundin(R) MCT/LCT) to reverse toxic dose local anesthetic-induced vasodilation in isolated rat aortas. METHODS: Isolated endothelium-denuded aortas were suspended for isometric tension recording. Vasodilation was induced by bupivacaine (3 x 10(-4) M), ropivacaine (10(-3) M), lidocaine (3 x 10(-3) M), or mepivacaine (7 x 10(-3) M) after precontraction with 60 mM KCl. Intralipid(R) and Lipofundin(R) MCT/LCT were then added to generate concentration-response curves. We also assessed vasoconstriction induced by 60 mM KCl, 60 mM KCl with 3 x 10(-4) M bupivacaine, and 60 mM KCl with 3 x 10(-4) M bupivacaine plus 1.39% lipid emulsion (Intralipid(R) or Lipofundin(R) MCT/LCT). RESULTS: The two lipid emulsions reversed vasodilation induced by bupivacaine, ropivacaine, and lidocaine but had no effect on vasodilation induced by mepivacaine. Lipofundin(R) MCT/LCT was more effective than Intralipid(R) in reversing bupivacaine-induced vasodilation. The magnitude of lipid emulsion-mediated reversal of vasodilation induced by high-dose local anesthetics was as follows (from highest to lowest): 3 x 10(-4) M bupivacaine-induced vasodilation, 10(-3) M ropivacaine-induced vasodilation, and 3 x 10(-3) M lidocaine-induced vasodilation. CONCLUSIONS: Lipofundin(R) MCT/LCT-mediated reversal of bupivacaine-induced vasodilation was greater than that of Intralipid(R); however, the two lipid emulsions equally reversed vasodilation induced by ropivacaine and lidocaine. The magnitude of lipid emulsion-mediated reversal of vasodilation appears to be correlated with the lipid solubility of the local anesthetic.
Amides ; Anesthetics, Local ; Animals ; Aorta ; Bupivacaine ; Emulsions ; Lidocaine ; Mepivacaine ; Rats ; Solubility ; Vasoconstriction ; Vasodilation

BACKGROUND: The Nuss procedure is a recently developed technique for minimally invasive repair of pectus excavatum using a metal bar. Although its technical simplicity and cosmetic advantages are remarkable, applications have been limited to children with standard pectus excavatum. We report a single center experience of the technique that has been evolving in order to correct asymmetric pectus configurations and adult patients. MATERIAL AND METHOD: Between August 1999 and June 2002, 322 consecutive patients underwent repair by the Nuss technique and its modifications. Among them, 71 (22%) were adults. For the precise correction, morphology of the pectus was classified as symmetric and asymmetric types. Asymmetric type was subdivided into eccentric and unbalanced types. In repair, differently shaped bars were applied to individual types of pectus to achieve symmetric correction. RESULT: Symmetric type was 57.5% (185/322) and asymmetric type was 42.5% (137/322). Eccentric, unbalanced, and combined types were 71, 47 and 19, respectively. Major modifications were bar shaping and fixation. In asymmetric group, different shapes of asymmetric bars were applied (n=125, 38.8%). For adult patients, double bar or compound bar technique was used (n=51, 15.8%). To prevent bar rotation, multipoint wire fixations to ribs were used. Major postoperative complications were pneumothorax (n=24, 7.5%) and bar displacement (n=11, 3.4%). 42 patient had bar removal 2 years after the initial procedure. CONCLUSION: The Nuss procedure is safe and effective.Modifications of the techniques in accordance with precise morphological classification enabled the correction of all variety of pectus excavatum including asymmetric types and adult patients.
Adult ; Child ; Classification ; Funnel Chest* ; Humans ; Pneumothorax ; Postoperative Complications ; Ribs