The search for a new flap with minimal donor morbidity has been pursued by many plastic surgeons. Numerous donor sites available for microsurgical composite tissue transplantation have been described owing to the tremendous advances made in the field of microsurgery. To be suifable for use as a free flap, a sizable vessel must be included within the tissue, leading to significant donor morbidity. There have been studies for prefabrication of an axial pattern flap in an effort to create a new flap, but most of these methods relied solely on revascularization of a preexisting composite tissue. Our experiment, using an isolated femoral artery and vein as the main pedicle, led to formation of a capsule flap through a normal foreign body reaction between 2 silastic sheet implants. On this induced capsule flap, a skin graft was performed and a total of 40 axial pattern capsulo-cutaneous flaps from 20 Sprague-Dawley rats were successfully obtained after nearly 12 weeks through 4 stages of experiment, including a delay procedure at the second stage. Pathology revealed neovascularization, and abundantly impregnated vascular structures near the pedicle were observed along with random pattern collagen fibers. The skin graft took 100% on this newlyformed axial pattern capsular flap and thus implied that the capsule structure was able to survive on it`s own and was able to support skin grafts. This new flap using only the isolated artery and vein structure can be induced according to various needs with minimal donor morbidity.
Arteries ; Collagen ; Femoral Artery ; Foreign-Body Reaction ; Free Tissue Flaps ; Humans ; Microsurgery ; Pathology ; Rats, Sprague-Dawley ; Skin ; Tissue Donors ; Tissue Transplantation ; Transplants ; Veins

Infectious endogenous endophthalmitis is a relatively rare, but seriously devasting disease. To evaluate clinical aspects of this disease, we performed a retreospective study on 7 eyes of 7 patients who had been treated with this diagnosis from July 1994 to January 1998 at Asan Medical Center. The preceding systemic diseases consisted of liver abscess, non-small cell lung cancer, spontaneous bacterial peritonitis, acute cholangitis, cystitis, systemic candidiasis. Microorganisms were recovered in blood culture in 4 of them(3 Klebsiella pneumoniae and one Candida albicans). One among these patients also revealed culture positive for Klebsiella pneumoniae in the vitreous as well as in his blood. All patients received intravitreal vancomycin and amikacin injection following vitreous and aqueous tapping. Four patients underwent pars plana vitrectomy as the second procedure and 2 of them expired. At the final follow up, retina remained attached succesjully in six of 7 eyes, yet the visual outcome was so poor that only two recovered over 5/200 or better. Infectious endogenous endophthalmitis has guarded prognosis since causative microorganisms are often extremely virulent, detection of this disease is likely to be delayed and appropriate management can not be started immediately. High index of suspicion for the diagnosis and the intensive treatment are strongly suggested to achieve the best result.
Amikacin ; Candida ; Candidiasis ; Carcinoma, Non-Small-Cell Lung ; Cholangitis ; Chungcheongnam-do ; Cystitis ; Diagnosis ; Endophthalmitis* ; Follow-Up Studies ; Humans ; Klebsiella pneumoniae ; Liver Abscess ; Peritonitis ; Prognosis ; Retina ; Vancomycin ; Vitrectomy

A clinieal Observation was done on the 110 cases (male; 52 cases, female; 58 cases) of duodenitis under the gastroduodenoscopic examination among the patients who were performed endoscopic examination because of seeking for the cause of dyspepsia period from Aug. 1981 to Sep. 1981 at Department of lnteral Medicine of BNUH. The results were summerized as follow 1) Normal finding(Grade 0) was highest as 40% in the incidence according to grade of duodenits. Next was moderate (Grade II & II) as 24. 5%, the 3rd was mild(Grade I) as 20% and lowest in severe(Grade IV) duadenitis as 15.5%, 2) Sex distribution of duodenitis showed 37 cases in male and 29 cases in female. And male was slightly higher in incidence than female. 3) Age distribution of duodenitis revealeii 3rd decade and 4th decade were highest in incidence, 30 cases and 28 cases respectively. The order of frequency was 5th decade, 6th decade, 1st decade and 7th decade. 4) Duodenitis was slightly higher in after 4th decade than before 4th decade. 5) The 56 cases of duodenitis except for 1 case were aasociated with gastroduodenal diseases such as gastritis, peptic ulcer or gastric carcinoma. Association of gastritis is highest as 79. 4%. 6) Acurracy of diagnosis in duodenitis on X-ray study was 3 cases in 20 cases. Generally X-ray study was little value in diagnosis of duodenitis.
Age Distribution ; Diagnosis ; Duodenitis* ; Dyspepsia ; Female ; Gastritis ; Humans ; Incidence ; Male ; Peptic Ulcer ; Sex Distribution

BACKGROUND: There are many reports about the correlation between cardiovascular disorders and estrogen deficiency in postmenopausal women. The purpose of current study is to know that postmenopausal estrogen therapy may affect the lipid metabolism and endogenous fibrinolytic system and exercise tolerance. METHOD: We investigated the relation of estrogen treatment (srogen 0.625 mg/day) to serum lipid levels, angiotensin converting enzyme activity, plasminogen activator inhibitor-1 and parameters of treadmill test in 22 postmenopausal women of normal coronary artery with abnormal exercise test complained with chest pain accompanied by postmenopausal symptoms. RESULTS: Estrogen treatment significantly elevated the serum HDL-cholesterol level (42.8 to 50.1 mg/dl, p<0.05) and reduced the PAI-1 level (16.2 to 10.4 ng/dl, p<0.01) without considerable side effects. During the exercise test, the positivity appearance time and total exercise duration is significantly increased after estrogen treatment. CONCLUSION: The postmenopausal use of estrogen favorably changed the lipid level, fibrinolytic system and might improve the microcirculation which may protect against the ischemic heart disease risk without significant side effects.
Chest Pain ; Coronary Vessels ; Estrogens* ; Exercise Test ; Exercise Tolerance ; Female ; Humans ; Lipid Metabolism ; Microcirculation ; Myocardial Ischemia ; Peptidyl-Dipeptidase A ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Postmenopause

Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.
Anesthesia, Conduction ; Anesthesia, General ; Breast* ; Female ; Humans ; Intercostal Nerves ; Methods ; Nerve Block* ; Pregnant Women* ; Thoracic Nerves ; Thorax

Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.
Anesthesia, Conduction ; Anesthesia, General ; Breast* ; Female ; Humans ; Intercostal Nerves ; Methods ; Nerve Block* ; Pregnant Women* ; Thoracic Nerves ; Thorax

OBJECTIVE: Our objective was (1) to determine if serum creatine kinase (CK) activity is reduced in rheumatoid arthritis (RA) compared with that of noninflammatory rheumatic diseases, (2) to examine the recently described association of low CK activity and disease variables in our RA population, and (3) to examine the influence of steroid on serum CK activity in patients with RA. METHODS: Cross sectional and longitudinal retrospective analyses of clinical and biochemical data of consecutive patients with RA and noninflammatory arthropathies. In all subjects we evaulated age, sex, weight, and, only for patients with RA, history of use of corticosteroids and Ritchie index. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin, and platelet count were simultaneously determined as variables of disease activity. CK activity was determined by automated biochemical analyzer (Hitachi 747, Japan). RESULTS: Serum CK activity was significantly reduced in RA (mean+SD: 45.7 +24.2 IU/L) compared to controls (81.3+33.9 IU/L) (p < 0.001). Ritchie index, CRP, and platelet count correlated inversely with CK values (correlation coefficient: 0.31, p < 0.01; 0. 45, p < 0.001; 0.42, p < 0.001, respectively). Patients taking steroids had lower CK activity than those without steroid, but not statistically significant.
Adrenal Cortex Hormones ; Arthritis, Rheumatoid* ; Blood Sedimentation ; C-Reactive Protein ; Creatine Kinase* ; Creatine* ; Humans ; Platelet Count ; Retrospective Studies ; Rheumatic Diseases ; Steroids

No abstract available.

BACKGROUND: Laparoscopic cholecystectomy has become the gold-tandard treatment for symptomatic gallbladder diseases. The evaluation and the treatment of common duct pathology is an essential component in the surgical management of biliary tract disease. The purpose of the present study was to identify the value and the importance of laparoscopic cholangiography compared to endoscopic retrograde cholangiography (ERC) in a laparoscopic cholecystectomy and to suggest the role of laparoscopic cholangiography in the management of patients undergoing laparoscopic cholecystectomy. METHODS: A laparoscopic cholecystectomy was attempted in two hundred six consecutive patients treated at Hallym University between January 1993 and December 1996. Patients were divided into three groups: In group I, 167 patients were examined with preoperative ERC while in group II, 17 patients were examined with laparoscopic cholangiography; Group III included 22 patients who were not examined with preoperative ERC or laparoscopic cholangiography. RESULTS: The average age was 52.78 years in group I, 45.62 years in group II, and 49.22 years in group III. The average operative time was 76.88 minutes in group I, 131.47 minutes in group II, and 85.22 minutes in group III. The operative time in group II was longer than that in group I (p<0.001). The duration of postoperative hospitalization was 4.9 days in group I and 4.11 days in group II, but this difference was not statistically significant (p=0.166). Conversion to an open cholecystectomy was 17/167 (10%) in group I, 1/17 (5%) in group II and 5/22 (22%). No complications or deaths occurred that were due to laparoscopic cholangiography. The postoperative complications in group I/II/III included bile leakage (3/0/2), bleeding in the bed of the gallbladder (5/0/0), wound bleeding (2/1/1), recurrent common duct stones (2/0/0), subcutaneous emphysema (4/1/0), shoulder pain (12/3/0), and wound infections (15/2/1). CONCLUSIONS: Although cholangiography may not be indicated for all patients undergoing a laparoscopic cholecystectomy, it will eventually be required. We conclude that laparoscopic cholangiography, as well as ERC, is a good method for evaluating the biliary tree. Laparoscopic cholangiography is clinically useful in patients who have negative ultrasonography and a dilated bile duct. Also, laparoscopic cholangiography has many advantages, especially at a teaching hospital: it outlines the anatomy of the extrahepatic biliary tree, identifies anomalies of surgical importance in time before iatrogenic damage is inflicted, detects stones in the cystic duct, discovers unsuspected stones, and develops experience with the technique. However, it is technically diffult to cannulate cystic duct and extends the operating time.
Bile ; Bile Ducts ; Biliary Tract ; Biliary Tract Diseases ; Cholangiography* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cystic Duct ; Gallbladder ; Gallbladder Diseases ; Hemorrhage ; Hospitalization ; Hospitals, Teaching ; Humans ; Operative Time ; Pathology ; Postoperative Complications ; Shoulder Pain ; Subcutaneous Emphysema ; Ultrasonography ; Wound Infection ; Wounds and Injuries

Ischemic stroke caused by spontaneous thrombosis of posterior inferior cerebellar artery (PICA) aneurysm has been rarely reported. A 52-year-old man presented with sudden headache, dizziness, and gait disturbance. Diffusion-weighted MRI showed acute infarction in left PICA territory. A saccular aneurysm with internal thrombus at the distal PICA was detected by CT angiography and conventional angiography. The thrombus resolved spontaneously at 2 months after stroke onset with aspirin medication. At that time, endovascular coiling was underwent successfully to prevent aneurysmal rupture.
Aneurysm* ; Angiography ; Arteries* ; Aspirin ; Cerebral Infarction ; Dizziness ; Gait ; Headache ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Middle Aged ; Pica ; Rupture ; Stroke ; Thrombosis*