We experienced satisfactory outcomes by synchronously transplanting an artery and vein using an anterolateral thigh flap pedicle between the vascular pedicle and recipient vessel of a flap for scalp reconstruction. A 45-year-old man developed a subdural hemorrhage due to a fall injury. In this patient, the right temporal cranium was missing and the patient had 4x3 cm and 6x5 cm scalp defects. We planned a scalp reconstruction using a latissimus dorsi free flap. Intraoperatively, there was a severe injury to the right superficial temporal vessel because of previous neurosurgical operations. A 15 cm long pedicle defect was needed to reach the recipient facial vessels. For the vascular graft, the descending branch of the lateral circumflex femoral artery and two venae comitantes were harvested. The flap survived well and the skin graft was successful with no notable complications. When an interposition graft is needed in the reconstruction of the head and neck region for which mobility is mandatory to a greater extent, a sufficient length of graft from an anterolateral flap pedicle could easily be harvested. Thus, this could contribute to not only resolving the disadvantages of a venous graft but also to successfully performing a vascular anastomosis.
Arteries ; Femoral Artery ; Free Tissue Flaps ; Glycosaminoglycans ; Head ; Hematoma, Subdural ; Humans ; Middle Aged ; Neck ; Scalp ; Skin ; Skull ; Thigh ; Transplants ; Vascular Grafting ; Veins

We have previously isolated a novel protein "B/K" that contains two C2-like domains. Here, we report the isolatioin and mRNA distribution of a human B/K isoform, and protein kinase A (PKA)-dependent phosphorylation of the B/K protein. The 1.5 kb human B/K cDNA clone exhibits 89% and 97% identities with rat B/K in the sequences of nucleotide and amino acid, respectively. Human B/K isoform encodes a 474 amino acid protein and shows structural features similar to the rat counterpart including two C2 domains, three consensus sequences for PKA, absence of a transmembrane region, and conservation of the N-terminal cysteine cluster. On Northern and dot blot analyses, a 3.0 kb B/K transcript was abundantly present in human brain, kidney, and prostate. Among the brain regions, strong signals were observed in the frontal and temporal lobes, the hippocampus, the hypothalamus, the amygdala, the substantia nigra, and the pituitary. Recombinant B/K proteins containing three consensus sites for PKA was very efficiently phosphorylated in vitro by PKA catalytic subunit. B/K protein which was overexpressed in LLC-PK1 cells was also strongly phosphorylated in vivo by vasopressin analog DDAVP, and PKA-specific inhibitor H89 as well as type 2 vasopressin receptor antagonist specifically suppressed DDAVP-induced B/K phosphorylation. These results suggest that B/K proteins play a role as potential substrates for PKA in the area where they are expressed.
Sequence Homology, Amino Acid ; Sequence Analysis, DNA ; Rats ; Protein Isoforms/genetics ; Phosphorylation ; Phosphoproteins/genetics/*metabolism ; Molecular Sequence Data ; Mice ; Male ; Humans ; Gene Expression Profiling ; Female ; DNA, Complementary/chemistry/genetics ; Cyclic AMP-Dependent Protein Kinases/*physiology ; Cloning, Molecular ; Cell Line ; Base Sequence ; Animals ; Amino Acid Sequence ; Adult

OBJECTIVES: Using two stimuli, this study was designed to evaluate variations of P300 in relations to reaction time of pressing the button for target tones in patients with schizophrenia. METHODS: The auditory oddball paradigm was used for the patients (N=22) and normal controls (N=23). The two stimuli were composed of target (20%, 2000 Hz, 75 dB) tone and standard (80%, 1000 Hz, 75 dB) tone, with 2 sec inter-stimulus interval, 50 msec duration and 10 msec rise or fall time. In each subject, P300s were acquired for both fast reaction time (FRT) and slow reaction time (SRT) to target response. RESULTS: P300 amplitude in patients with schizophrenia was lower than controls across FRT and SRT (p<0.001), but P300 latency was not delayed (p>0.8). In this study, even though the reaction time for the button pressing task might be faster in patients with schizophrenia (p<0.1), the P300 to FRT in patients with schizophrenia was lower than the P300 to SRT in controls (p<0.01). CONCLUSION: These results suggest that the lower P300 in patients with schizophrenia might be due to cognitive dysfunction and the patient's performance in reaction time for pressing buttons, both independently. Thus, P300 as well as reaction time may be used to further explore a variety of domains of cognitive function.
Evoked Potentials* ; Humans ; Reaction Time* ; Schizophrenia*

Background : Preoperative radiochemotherapy (RCT) has been administered for locally advanced rectal cancer to increase the therapeutic benefits, and to preserve the sphincter in low-lying tumors, however, tumor responses after RCT are variable. Methods : Apoptotic index (AI), and expressions of Ki-67, p53 and bcl-2 were analyzed in pretreatment biopsies from 69 patients with rectal cancer by immunohistochemistry. Tumor response was graded in surgically resected specimens by using a three-scale grading system: no response (NR), partial remission (PR) and complete remission (CR). Results : CR was identified in 19 cases (28%), PR in 24 cases (35%), and NR in 26 cases (38%) of 69 cases. p53 protein was expressed in 49 cases (71%), whereas bcl-2 was in 42 cases (61%). The pretreatment Ki-67 labeling index was 65.4+/-3.4%. The tumor response was not associated with any of these markers. Tumors with CR/PR showed a higher AI (0.84+/-.84%/0.66+/-.52%) than that of tumors with NR (0.58+/-0.54%). There was a significant correlation between tumor response and the histologic differentiation (p=0.008) or recurrence (p=0.039). Conclusions : The AI revealed a tendency to increase in tumors with CR/PR, while expressions of p53 and bcl-2, and Ki-67 labeling index had little direct association with tumor response.
Apoptosis* ; Biopsy ; Chemoradiotherapy* ; Humans ; Immunohistochemistry ; Rectal Neoplasms* ; Recurrence

Nowadays, nonincisional double eyelid operation is preferred by lots of patients and surgeons. There are a variety of suture methods but all the suture procedures-including continuous buried suture methods-in the literatures penetrate the conjunctivas. So due to the pain, surgeons had to infiltrate local analgesics into the conjunctiva. This horrifies the patients, gives pain, makes the eyelids and conjunctivas swollen, and sometimes interrupts the movements of the eyelids by affecting the levator palpabrae muscles. This condition could make the eyelid folds asymmetric. Authors changed the procedure by using a chalazion forcep with a small slit which allows the suture materials to get out and we could successfully perform the suture without penetrating the conjunctiva. So we could make double folds maintaining the patient's dynamic and static conditions very well since no direct local analgesics were needed for the conjunctivas, and the results were pretty satisfactory.
Analgesics ; Chalazion* ; Conjunctiva ; Eyelids* ; Humans ; Muscles ; Surgical Instruments* ; Sutures*

A wide variety of pulmonary disorders related to hemodialysis or pre-existing renal disease occurs in hemodialysis patients. The disorders may be classified as 1) pulmonary abnormalities associated with chronic renal failures; 2) pulmonary complications arising during hemodialysis; 3) pulmonary infection; or 4) pulmonary-renal syndrome. An awareness of the various possible pulmonary disorders arising in hemodialysis patients may be helpful for the proper and timely management of such patients. We describe and illustrate various radiographic and CT findings of variable pulmonary disorders in hemodialysis patients.
Humans ; Renal Dialysis* ; Renal Insufficiency ; Vasculitis

The callotasis is widely used in lengthening of bones without bone graft. We thought that the accompanying vessels is critical in the viability of distal tissue to the lengthened area and has an important effect on the bone-lenthening itself. So we made an assumption that the accompanying vessels is adapted to the lengthening via neogenesis more than simple physical stretching. At this, we placed a pair of small external fixator in the left tibiae of ten Spraugue-Dawley rats and made an osteotomies. At two weeks after 25% lengthening, vessels of both lengthened and unlengthened side was harvested and five sections from each vessels were stained with BrdU immunohistochemical staining. We investigated the DNA synthesis counting the number of BrdU labeled cells. The number of BrdU labeled cells is significantly increased in the lenthened side arteries(p<0.0001). The synthesis of DNA was significantly increased in the center rather than the ends (p<0.0001). And there was no difference between the number of the BrdU labeled cells of proximal part and that of distal parts(p=0.316). It means that the accompanying vessles in the distraction-lengthening are adapted to the lengthening not only by just physical stretching but also by neogenesis of vascular cells.
Animals ; Bromodeoxyuridine* ; DNA ; External Fixators ; Immunohistochemistry* ; Osteogenesis, Distraction* ; Osteotomy ; Rats ; Rats, Sprague-Dawley* ; Tibia* ; Transplants

PURPOSE: Insulinomas are a rare disease, which can be cured by surgical management if diagnosed early. However, diagnosis and localization are difficult, due to their small size and varied clinical manifestations. We analyzed the clinicopathological features, diagnosis and surgical management of insulinomas. METHODS: We retrospectively analyzed 12 insulinoma patients who had undergone pancreatic surgery, between 1988 and 2001, at the Department of Surgery, College of Medicine, The Catholic University of Korea. RESULTS: The male to female ratio of the insulinoma patients was 1: 1 with a mean age of 37.9 years, ranging from 20 to 65. The clinical manifestations were loss of consciousness, weakness, confusion and dizziness, and all the patients had findings compatible with Whipple's triad. The median duration of symptoms before surgery was 16.8 months, ranging from 1 to 48 months. Hyperinsulinemic hypoglycemia was confirmed, during prolonged fasting, when the concomitant fasting blood sugar level was 42.4mg/dl and insulin level was 25.2 microU/ml (8.1~61.8 microU/ml). The insulinoma can be localized in 11 patients (91.7%) preoperatively. For the preoperative localization, a transhepatic portal vein sample (THPVS), selective angiography and a CT scan were good diagnostic methods. Intraoperative ultrasonography was the most useful localization tool during the operation. For treating the insulinoma, an enucleation, a distal pancreatectomy, and a pylorus preserving pancreaticoduodenectomy were performed in 5, 6 and 1 patients, respectively. An enucleation case was diagnosed as nesidioblastosis after surgery, thus needing a near total pancreatectomy. One patient with a multiple endocrine neoplasia (MEN), subtype I, needed a thyroidectomy and an adrenalectomy. All cases were single, benign tumors within the pancreas. The symptoms of hypoglycemia and the laboratory values were normal in all patients after surgery. CONCLUSION: We experienced 12 insulinoma patients, where preoperative suspicions, proper utilization of diagnostic tools, and prudent intraoperative diagnostic procedures enhanced the diagnostic accuracy of the insulinoma, and led to better treatment strategies.
Insulinoma* ; Pancreas*

Along with aural atresia, abnormalities of the middle ear and external ear canal can impede the audition of the developing infant. In cases of bilateral atresia when bone-conduction aids fail to adequately restore impaired hearing, unilateral canal reconstruction may be required at a very early age to enable proper speech and language development. We are often confronted by cases in which canaloplasty has previously been performed by ENT surgeons, leaving auricular canals of various locations and sizes in addition to scars. In such cases, it can be difficult to prepare a skin flap sufficient in size to cover the cartilagenous framework for auricular reconstruction. Scar tissues with relatively poor vascularity induced by a prior incision and elevation of the soft tissue may compromise the ultimate result of auricular reconstruction. To obtain the sufficient, thin, pliable and well vascularized skin, we used tissue expansion at the first stage of the auricle reconstruction in microtia patients who previously received canaloplaty. From December, 1988 to February, 1999, we attempted tissue expansion using volume 35cc, cresent- type inflatable silicone expanders(SebbinR) in 12 patients who previously received canaloplasty. Ear frameworks were prepared using autologous rib cartilage. The expanded skin provided sufficient, thin, pliable, and well vascularized skin for easy draping and better contouring. The reconstructed auricle was satisfactory in both color and texture and had nearly normal sensation. No resorption of the inserted rib cartilage has been observed from 7 months to 9 years and 9 months after the operation.
Cartilage* ; Cicatrix ; Ear ; Ear Canal ; Ear, Middle ; Hearing ; Humans ; Infant ; Language Development ; Ribs* ; Sensation ; Silicones ; Skin ; Tissue Expansion ; Tissue Expansion Devices* ; Transplants*

Extensive clinical research has demonstrated that the 585-nm pulsed dye laser(PDL) is effective in eradicating port-wine stains(PWS) and telangiectasia with an extremely low incidence of scarring. The successful treatment of laser therapy is based on selective photothermolysis of blood vessels without damaging the normal overlying epidermis. Unfortunately, the native epidermal melanin acts as an optical shield that absorbs the laser light and reduces the heat generated in blood vessels. When melanin absorbs laser light, the resultant temperature increase can induce epidermal blistering. In these patients, the laser treatment dosages must be kept low, often subtherapeutic, to avoid damage to the epidermis and to prevent the possibility of scarring. Cryogen spray cooling of skin may be an effective method for minimizing epidermal thermal injury. The objective of this study is to determine histologically the effectiveness of the cryogen cooling by spraying the skin with a brief spurt of cryogen prior to the laser pulse, so as to reduce epidermal damage (hypo/hyperpigmentation) caused by this laser. We present a histologic study of the thermal response of the skin of the Sprague-Dawley rats to spray cooling in conjunction with 585-nm pulsed dye laser irradiation with 6J/cm. Both treatment sites with and without the use of the cryogen spray were compared. Under light microscope, the epidermal and dermal histologic changes were compared. A significant reduction in epidermal damage was found in study groups using the cryogen cooling without changing the efficacy of the laser treatment statistically. And a significant reduction in healing periods was observed in study groups using the cryogen cooling prior to the laser pulse. This study suggests that cryogen cooling can reduce epidermal damage during PWS treatment with the 585-nm PDL without reducing treatment efficacy. The absence of epidermal damage suggests that precooling with the cryogen may allow the use of higher laser input to expedite clearance without inducing epidermal change.
Blister ; Blood Vessels ; Cicatrix ; Epidermis ; Hot Temperature ; Humans ; Incidence ; Laser Therapy ; Lasers, Dye* ; Melanins ; Port-Wine Stain ; Rats, Sprague-Dawley ; Skin ; Telangiectasis ; Treatment Outcome