This study was designed to assess the effects of compound madecassol(madecassic acid with neomycin sulfate and hydrocortisone acetate) on the wound healing. Madecassol is a titrated extract of centella asiatica and the clinical effects of madecassol are stated to the enhancement of wound healing and the prevention and relief of excessive scar formation. Compound madecassol is composed of madecassol and neomycin sulfate and hydrocortisone acetate. Neomycin sulfate has antibiotic effect and hydrocortisone acetate has antiinflammatory and antiallergic effects. So, compound madecassol has a synergistic effect of madecassol as well as neomycin sulfate and hydrocortisone acetate. Using 54 rats, we compared the effect of compound madecassol on wound healing at 3rd, 7th, 14th, and 21th postoperative days. This study examined the histologic findings and the gross findings which were wound size, epithelization and quality of granulation tissue. In this study, compound madecassol showed lower degree of inflammatory infiltration, shorter inflammatory phases and less wound contraction. The number of the myofibroblast in the group of compound madecassol were fewer than other groups. Granulation tissue of the compound madecassol was relatively healthier than others. There were no significant difference of re-epithelization between compound madecassol and other groups. In conclusion, compound madecassol can reduce excessive wound contraction and promotes wound healing process.
Animals ; Centella ; Cicatrix ; Granulation Tissue ; Hydrocortisone ; Myofibroblasts ; Neomycin ; Rats ; Wound Healing* ; Wounds and Injuries*

No abstract available.

Pseudoxanthoma elasticum (PXE) is an uncommon heritable disorder of elastin characterized by cutaneous, ocular and vascular abnormalities. Typical skin lesion shows yellowish papules and redundant skin folds on the neck, axilla and groin due to degeneration and calcification of elastic fibers in deep dermis. As in all heritable disorders of connective tissue, no curative therapy is presently know. Redundant and unsightly skin folds about the neck can be improved by surgery, but irregular papular lesion on skin does not improved by surgery. A-44-year-old female who had a skin lesion and angioid streak was treated as follows: Skin folds on the neck were excised successfully without any significant problem such as intraoperative bleeding, wound dehiscence or hypertrophic scar formation. To evaluate whether we could smooth the irregular skin surface due to multiple papules, laserbrasion with a SLT contack Nd:YAG laser system was performed experimentally on a limited area which was located on the right supracla-vicular area about 2 x 3cm in size. An acceptable aesthetic appearance was achieved with surgical excision 12 months after the operation. Biopsy of the laserbrasion site revealed disappearance of the calcium deposit. This study emphasizes the possibility of using laserbrasion in solving troblesome skin lesion of the PXE.
Angioid Streaks ; Axilla ; Biopsy ; Calcium ; Cicatrix, Hypertrophic ; Connective Tissue ; Dermis ; Elastic Tissue ; Elastin ; Female ; Groin ; Hemorrhage ; Humans ; Neck* ; Pseudoxanthoma Elasticum ; Skin ; Wounds and Injuries

A possible therapeutic effect of acetyl-L carnitine (ALCAR) on peripheral nerve injuries and the expression of Jun, the protein products of immediate-early genes(IEGs), in the spinal cord were investigated after sciatic nerve injury in Sprague-Dawley rats. Experimental animals were divided into 3 groups: intact sciatic nerve as a control group, surgical repair alone, and surgical repair with ALCAR treatment. Toe-spreading response, pinprick response, and compound action potential were measured to evaluate the recovery of sciatic nerve injury. Recovery of behavioral function and electrophysiological function both improved in the surgical repair with ALCAR treatment group. Weak basal expression of Jun was shown in the ventral horn the of spinal cord in the control group. In the surgical repair alone group or the surgical repair with ALCAR treatment group, Jun expression persisted until 28 days after injury in the ventral horn of the spinal cord. Moreover, the surgical repair with ALCAR treatment group showed more increased expression of Jun than the surgical repair alone group. These results suggest that ALCAR facilitates the functional recovery after peripheral nerve injury.
Acetylcarnitine ; Action Potentials ; Animals ; Carnitine* ; Horns ; Peripheral Nerve Injuries ; Rats* ; Rats, Sprague-Dawley ; Sciatic Nerve* ; Spinal Cord

Repairing of lacrimal canalicular laceration has some controversies on the golden time of surgery, the suture method, and the materials for stent. Recently, intubation of silicone tubes has become popular for repair of lacrimal canalicular injuries. Thirty-two cases of injured lacrimal canaliculi were repaired with use of silicone tube stents. The surgery can be done with monocanalicular(10 patients) or bicanalicular(22 patient) methods. The follow-up period was from two to eighteen months(mean ten months). Seven cases using the monocanalicular method and nineteen cases using the bicanalicular method were successful. Three cases of monocanalicular method had epiphora with canalicular obstruction due to early loss of the silicone tube. In monocanalicular method, postoperative complications were punctal granuloma(1 case), punctal slits(2 cases), and early loss of the silicone tube(3 cases). In bicanalicular method, postoperative complications were persistent epiphora during the period of intubaion(4 cases), conjunctival irritation sign(3 cases) and loop retraction(1 case). In conclusion, the success rate of bicanalicular stents were higher than that of monocanalicular stents for canalicular laceration. But the bicanalicular stent had some complications including cosmetic problem, possibility of injuries to the normal canaliculus during intubation, conjuntival irritation sign, and loop retraction.
Follow-Up Studies ; Intubation* ; Lacerations ; Lacrimal Apparatus Diseases ; Postoperative Complications ; Silicones* ; Stents ; Sutures

Enterococcus is a gram positive coccus and a normal flora in gastrointestinal tract, but it could raise opportunistic infection. In 1986, vancomycin resistant enterococcus(VRE) was reported in Europe at first. Recently, the incidence is increasing in USA and Korea(2~8%). In our hospital, sore and stool cultures for enterococcal identification were carried out on 4 patients with sore wound. By screening stool culture, VRE was detected in 3 of 4 pressure sore patients. VRE was also identified from the sore wound in 2 of 3 patients who had VRE positive in screening stool culture. 2 of 4, enterococcal positive patients, have the history of vancomycin use in the past. An increasing number of VRE infection in hospital suggest that VRE become an important cause of infected pressure sore. Therefore, culture of sore wound and stool for the identification of VRE should be performed routinely.
Enterococcus ; Europe ; Gastrointestinal Tract ; Humans ; Incidence ; Mass Screening ; Opportunistic Infections ; Pressure Ulcer ; Vancomycin ; Wounds and Injuries*

The purpose of this article is to describe an alternative approach to the nasal septum and the advantages offered by the decortication septorhinoplasty in correcting difficult nasal deformities. Using the Decortication septorhinoplasty approach, the entire cartilagenous septum can be exposed so that each specific deformity can be visualized and corrected appropriately. Retracting the lateral crura laterally, a midline plane is dissected, and the anterior septal angle and dorsal margin of the septal cartilage is identified. The elevation of the mucoperichondrium is started at the area of the anterior septal angle. After anterior approach, scissors are inserted between the septal cartilage and the upper lateral cartilage and their junction is sharply divided. Elevation of the rest of the mucoperichondrium is completed as a skeletonized single unit. Sculpting the entire cartilagenous and/or bony vault, as well as correcting difficult septal malalignments, can be carried out under better direct vision with great precision, accuracy, and predictability. From January 2000 till March 2001 the decortication approach is used for correcting difficult nasal deformity in 24 patients. Of these, 5 are secondary cleft lip nose, 10 are deviated nose, 5 are traumatic saddle nose, and 4 are hump nose. The mean follow up period is 12 months, ranging from 5 to 20 months. The patients are overall satisfied with the aesthetic and functional results. The disadvantage and complication of the Decortication septorhinoplasty is the same as compared to the conventional open rhinoplasty. The decortication approach is most suited for correction of deformities at the dorsal aspect of the nasal septum that causes a twisted nose deformity, of deformities at the anterior septal angle causing an asymmetric tip, and of deformities along the caudal aspect of the quadrangular cartilage producing columellar distortion, and of relational deformities between anterior nasal spine and septum. The decortication technique has provided a effective avenue for the correction of severe nasal deformities.
Cartilage ; Cleft Lip ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Nasal Septum ; Nose ; Rhinoplasty ; Skeleton ; Spine

The traumatic optic neuropathy occurs in 0.5 to 5% of closed head trauma cases. Because it may cause permanent blindness, the early diagnosis and proper treatment are very important. We have treated 6 traumatic optic neuropathy patients among 433 head trauma cases from Sep, 1997 to Aug, 1998. Four patients showed visual recovery with steroid therapy. The diagnosis can be made clinically when the patient suffers from acutely decreased vision, Marcus-Gunn pupil, with its relatively normal fundoscopic finding, is considered as the most sensitive indicator and the first herald of visual tract injury, even though visual acuity is normal at the initial stage. The megadose steroid therapy must be diagnosed for the recovery of incompletely injured axons rather than regeneration. The optic canal decompression surgery must be spared for the delayed onset optic neuropathy patients who do not respond to the steroid therapy. In a case of indirect optic neuropathy, the associated orbital fracture reduction should not be undertaken until the optic neuropathy has stabilized. But severely displaced blow-in fracture of the orbit that decreases orbital volume should repaired early for orbital decompression.
Axons ; Blindness ; Craniocerebral Trauma ; Decompression ; Diagnosis ; Early Diagnosis ; Head Injuries, Closed ; Humans ; Optic Nerve Diseases ; Optic Nerve Injuries* ; Optic Nerve* ; Orbit ; Orbital Fractures ; Pupil Disorders ; Regeneration ; Visual Acuity

Paraffinoma on nose from injection of paraffin by the quack doctor for the purpose of augmentation rhinoplasty has so many problem, especially when invaded overlying nasal skin. 6 cases of skin involved severe paraffinoma were treated by one step reconstruction with pericraniosubgaleal flap and follow up periods was 2 to 17 months. All patients were successfully treated without any complications and had satisfactory results. In cases of three telangiectasis among six patients, the severity of telangiectasis was improved, but not completely. We believe that the advantages of this method are one step reconstruction and good vascularity, which prevent infection and enable easy to make variable shape. When the overlying skin loss was developed, the flap became tolerable graft bed. The authors conclude that the pericraniosubgaleal flap is one of the reliable surgical options for treatment of the skin involved severe nasal paraffinoma.
Follow-Up Studies ; Humans ; Nose ; Paraffin ; Rhinoplasty ; Skin* ; Telangiectasis ; Transplants

BACKGROUND: To reduce massive blood loss during a hepatectomy, many anesthesiologists have used the technique of low central venous pressure maintenance by administration of low dose nitroglycerin (NTG) and/or intravenous fluid reduction. However, so far there have been no studies about local liver perfusion (LLP) changes after hepatic artery (HA) or portal vein (PV) reperfusion in patients receiving nitroglycerin administration. In this study, the changes in hemodynamics and LLP following HA and PV reperfusion along with low dose (2micro gram/kg/min) NTG administration in dogs were observed. METHODS: A total of 20 mongrel dogs were divided into four groups; HA occlusion and reperfusion group (H, n = 5), NTG administration group during the reperfusion on H (H-NTG, n = 5), PV occlusion and reperfusion group (P, n = 5), NTG administration group during the reperfusion on P (P-NTG, n = 5). After femoral and pulmonary arterial catheterization, a midline abdominal incision was made. HA and PV were exposed to clamp and declamp. A thermal diffusion microprobe was inserted in the liver parenchyme to measure LLP. RESULTS: The PV blood flow was not changed after HA occlusion, but HA blood flow increased after PV occlusion. The LLP decreased after HA and PV occlusion. The LLP recovered to the baseline level in group H-NTG after HA reperfusion, but the LLP was more increased compared to the baseline level in group H. In group P, the LLP did not recover after PV reperfusion, but the LLP in group P-NTG recovered to the baseline level after PV reperfusion. CONCLUSIONS: In conclusion, it was observed that the LLP recovered to the baseline level by administration of NTG after PV reperfusion. However, the LLP did not increase after HA reperfusion by administration of low dose NTG.
Animals ; Catheterization ; Catheters ; Central Venous Pressure ; Dogs* ; Hemodynamics* ; Hepatectomy ; Hepatic Artery* ; Humans ; Liver* ; Nitroglycerin* ; Perfusion* ; Portal Vein* ; Reperfusion* ; Thermal Diffusion