The objectives of this study sere to investigate how the local irradiation affect the survival of random pattern skin flap, and whether or not hyperbaric oxygen and allopurional can improve the survival of the irradiated rat skin flap. There have been many reports about the effects of hyperbaric oxygen and allpurinol on skin flaps. However, very few reports have been presented on the effects of hyperbaric oxygen and allpurinol in treating irradiated skin flaps. The author examined the local irradiation effect on rat skin flap survival after irradiation of 20 Gy, 3 days postoperatively, on cranially based random pattern dorsal skin flap, which was 3 x 9cm in size. The flap survival length was measured in experimental groups treated with hyperbaric oxygen (2.5 atm absolute, 100% oxygen, once a day for 7days) after irradiation and with hyperbaric oxygen combined with allopurinol (100mg/kg, once a day for 7 days), in comparison with a radiation-only group. On reviewing the flap survival length 10 days postoperati-vely, the average flap survival length in the radiation-only group was 2.2+/-0.5cm, while in the non-radiation group it was 5.5+/-0.3cm. The reduction ratio of flap survival by irradiation was 60%. There was a significant increase in the mean flap survival length in the groups treated with hyperbaric oxygen (4.0+/-1.6cm) and hyperbaric oxygen combined with allopurinol (5.5+/-1.8cm). The increased ratio of flap survival in each group was 85% and 150% when compared to the radiation-only group. The author found that rat skin flap survival decreased, even at an early stage, as a result of high dose local irradiation and that decreased flap survival by irradiation could be restored by hyperbaric oxygen and allopurinol. The group treated with hyperbaric oxygen combined with allopurinol showed increased flap survival over the group treated with hyperbaric oxygen only. The results showed a method which could possibly increase flap survival in cancer patients who require early radiation after flap surgery.
Allopurinol* ; Animals ; Humans ; Oxygen* ; Rats* ; Skin*

Purposes : Nitric oxide (NO) is classified as toxic gas in native states, but in most biologic systems NO acts as a messenger molecule. NO is known as endothelium derived relaxing factor that modulates tone of vascular smooth muscle. Inhaled NO has been reported to act as a selective pulmonary vasodilator and we expect that NO inhalation can be used as a successful treatment modality in the management of persistent pulmonary hypertension of the newborn. We used the newborn piglet to create acute hypoxic pulmonary hypertension and examined the hemodynamic effect of inhlaled NO and dose-response characteristics in different concentrations of NO in this model. The aims of this study were to investigate the feasibility and safety of administering NO to a neonatal model and to get a useful informations about clinical applications of administering NO. METHODS: Nine 2-to 9-d-old piglets with an average weight of 3.1+/-0.86kg were anesthetized, intubated and instrumented in order to measure the hemodynamic variables. NO in nitrogen in a concentration of 800 ppm in 47 liter sylinder was obtained and injected into the inspiratory line of a time-cycled pressure-limited neonatal ventilator after reducing of pressure using 3 staged regulator. Gas mixture in downstream of the injection site was analyzed for NO and NO2 using electrochemical analyzer. Statistical analyses were done using with SAS software ver. 6.04. RESULTS: Baseline hemodynamic parameters in normoxic breathing such as mean systemic arterial pressure, mean pulmonary arterial pressure, systemic vascular resistance, pulmonary vascular resistance and cardiac index were 79+/-18mmHg, 16+/-4mmHg, 0.20+/-0.09mmHg, mL-1, min, kg, 0.04+/-0.02mmHg, mL-1, min, kg, and 399+/-201mL/min/kg respectively. Inhaling 20 and 80 ppm NO during ventilation at FIO2 0.21 did not produce any significant changes in hemodynamic indices. Pulmonary hypertension was induced by reducing the fraction of inspired oxygen to 0.10 to 0.15 and arterial oxygen saturation between 35 and 45%. The hypoxic challenge caused a significant increase in pulmonary arterial pressure, pulmonary vascular resistance and the ratio of pulmonary to systemic vascular resistance of 105% (P<0.001), 92% (P<0.02), 72% (P<0.01) respectively. Systemic arterial pressure increased by 20% (P<0.05), but systemic vascular resistance and cardiac index were not changed significantly. Inhaled NO was then administered in concentrations of 10, 20, 40, 80, and 100 parts per million in random order. All concentrations of NO were associated with a rapid decrease in pulmonary arterial pressure and pulmonary vascular resistance (P<0.02, P<0.001). The ratios of pulmonary to systemic vascular resistance decreased with all levels of inhaled NO (P<0.05). There was no significant difference between the different doses of NO in their effects. There was no significant increase in circulating methemoglobin, and the NO2 levels in the inspiratory limb of ventilator never exceeded 1.5 ppm. Plasma nitrite and nitrate increased in a dose-dependent manner (P<0.05). CONCLUSIONS: In acute hypoxic pulmonary hypertension induced newborn piglets NO inhalation with all the varying concentrations led to reduction of pulmonary arterial pressure promptly and safely without significant increase of methemoglobin and NO2 levels.
Animals ; Arterial Pressure ; Endothelium-Dependent Relaxing Factors ; Extremities ; Hemodynamics* ; Humans ; Hypertension, Pulmonary* ; Infant, Newborn* ; Inhalation* ; Methemoglobin ; Muscle, Smooth, Vascular ; Nitric Oxide* ; Nitrogen ; Oxygen ; Plasma ; Respiration ; Vascular Resistance ; Ventilation ; Ventilators, Mechanical

Recent literatures suggest that pulmonary embolus secondary to renal cell cancer may be more common than previously suspected. A 63-year-old man, who suffered a massive tumor embolism to the right main pulmonary artery after surgery for renal cell carcinoma with vena caval and renal vein invasion, was treated by emergency pulmonary embolectomy using cardiopulmonary bypass. Renal cell carcinoma occasionally extends into the inferior vena cava as a tumor thrombus. In such patients, removal of the tumor thrombus from the inferior vena cava has to be performed in addition to radical nephrectomy. However, the massive pulmonary tumor embolism is a major potential hazard during radical surgical resection. To prevent intraoperative pulmonary embolisms, scheduled use of cardiopulmonary bypass with the cooperation of cardiovascular surgeons is recommended in addition to the standard proximal vena caval occlusion technique of clipping and clamping.
Carcinoma, Renal Cell* ; Cardiopulmonary Bypass ; Constriction ; Embolectomy ; Embolism ; Emergencies ; Humans ; Middle Aged ; Neoplastic Cells, Circulating* ; Nephrectomy ; Pulmonary Artery ; Pulmonary Embolism ; Renal Veins ; Thrombosis ; Vena Cava, Inferior

No abstract available.
Adolescent* ; Blood Pressure* ; Humans

Shigella sonnei KNIH104S, which was selected by Korean National Institute of Health, expresses form I-antigen as a somatic antigen. In this study, we cloned the genes responsible for form I-antigen synthesis from S. sonnei KNIH104S. A Sau3AI-generated cosmid library of S. sonnei KNIH104S plasmids were transfected into E. coli LE392 and transfectants were tested for agglutination with antiserum against S. sonnei form I-antigen. A clone, JH222, showing the strongest agglutination activity was chosen for further analysis. A recombinant cosmid, pJH222, was isolated from the strain JH222 and retransfected into E. coli LE392. All of the transfectants agglutinated with antiserum against form I-antigen, indicating that pJH222 carried the genes required for S. sonnei form I-antigen synthesis. Restriction analysis of pJH222 revealed a 38 kb insert, which was confirmed by Southern hybridization analysis to be present on a large plasmid of S. sonnei KNIH104S.
Agglutination ; Clone Cells* ; Cloning, Organism* ; Cosmids ; Plasmids ; Shigella sonnei* ; Shigella*

The causes of temporomandiublar joint(TMJ) ankylosis are classified into trauma, systemic or local infection, and systemic diseases. Recent reports have implicated taruma as the main cause, with infection being a distant one. Local infections of surrounding structures(eg, mastoiditis and otitis media) can spread to TMJ by a direct extension or a hematogenous spread. In childhood, dense barrier of bone between the middle ear and the joint cavity may not be developed to prevent the spead of the infection. Otitis media is known to be a common complication of measles in children. Therefore children are more susceptible to TMJ ankylosis secondary to otitis media caused by measles. In the present case, the patient was 21 years old. At the age of 5 years, he had been caught by measles and accompanying otitis media. Since then, he had suffered from trismus for over 15 years. He was diagnosed as bony ankylosis of the left TMJ. We reconstructed his TMJ with 1) the resection of the condylar mass, 2) ipsilateral coronoidectemy, 3) contralateral coronoidectomy, 4) recontouring of glenoid fossa, and 5) replacement with a metal prosthesis(titanium condyle). In the choice of the graft material, we preferred metal prosthesis to autogenous costochnodral rib bone because the patient was still in the state of chronic otitis media and mastoditis. His mandibular function was improved significantly postoperatively. Unitl now he gets along without any postoperative complication.
Ankylosis* ; Child ; Ear, Middle ; Humans ; Joints ; Mastoid ; Mastoiditis ; Measles ; Otitis Media* ; Otitis* ; Postoperative Complications ; Prostheses and Implants ; Ribs ; Temporomandibular Joint* ; Transplants ; Trismus ; Young Adult

No abstract available.

No abstract available.
Brain* ; Epilepsy* ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: To test the hemodynamic and biochemical sequences of secondary cerebral energy failure after acute reversed hypoxic ischemic brain insult (HI) can be reproduced in newborn piglets. METHODS: Fifteen anesthetized, ventilated newborn piglet (<3 day) were studied. Eight (HI) were induced transient HI by breathing 8% oxygen and complete occlusion of bilateral common carotid arteries for 30 minutes followed by reoxygenation and reperfusion. Seven (control) were given a sham operation. Both groups were maintained for 48 hours with intensive care and monitoring of cerbral hemodynamics and [delta Cyt aa3] using near infrared spectroscopy (NIRS). Finally, brain cortex was harvested and determined activities of Na+, K+/-ATPase, level of conjugated dienes, ATP and phosphocreatine (PCr) biochemically. RESULTS: No changes took place in the 48-hour control group. In HI group, PaO2, pH, and MABP decreased, and heart rate, glucose, lactate level in blood and lactate level in CSF increased during acute HI. These variables subsequently returned to normal with time. In continuous NIRS monitoring, [delta Cyt aa3] were not changed in the control group. But in HI group [delta Cyt aa3] decreased significantly in acute HI and then normalized with resuscitation but gradually decreased and was significantly lower than control group at 48 hours. Cerebral Na+, K+/- ATPase activity and ATP, PCr level of experimental group significantly decreased compared to control group. Cerebral level of conjugated dienes were not significantly different between both group. CONCLUSION: We successfully reproduced secondary cerebral energy failure after acute HI in thenewborn piglet and this animal model may be useful for testing cerebroprotective strategies.
Adenosine Triphosphatases ; Adenosine Triphosphate ; Animals ; Anoxia ; Brain ; Carotid Artery, Common ; Glucose ; Heart Rate ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn ; Critical Care ; Ischemia ; Lactic Acid ; Models, Animal ; Oxygen ; Phosphocreatine ; Polymerase Chain Reaction ; Reperfusion ; Respiration ; Resuscitation ; Spectroscopy, Near-Infrared* ; Spectrum Analysis

Swallowing caustic materials may produce full-thickness burn and loss of esophageal function. Caustics, both acid and alkalis, can corrode and destroy living tissue. Full-thickness burn of esophiageal epithelium causes severe stricture which frequently requires surgical repair. Recently, non-operative dilatation of luminal stenosis has been utilized. Esophageal endoscopic endoprosthesis has been used widely in malignant esophageal stricture but not in benign stricture. In recurrent benign esophageal stricture following repetitive balloon dilatation, we experienced a case of an 18-year-old woman with severe stricture which was successfully managed by esophageal endoprosthesia So we report this case with the review of the literature.
Adolescent ; Alkalies ; Burns ; Caustics ; Constriction, Pathologic ; Deglutition ; Dilatation ; Epithelium ; Esophageal Stenosis* ; Female ; Humans ; Lye* ; Phenobarbital