Biomedical subjects
Publications and source records attributed to S M Baek.
Previously, 6 to 10 hr were believed to be an acceptable limit of warm ischemia for successful digital replantation. The longest warm ischemia time ever reported was 33 hr. This report presents successful replantations of two fingers after 42 hr of warm ischemia.
Reduction malarplasty is one of the common aesthetic procedures performed in the Orient, although it is rarely performed in the West. Previously described techniques for malar reduction include shaving the prominent portion and contouring the outer surface of the malar complex utilizing a variety of surgical approaches. We describe a technique for malar reduction involving a coronal approach followed by either an in situ transposition osteoplasty or the removal of the malar complex and contouring of the bone with replacement as a free bone graft. We have performed this procedure on 94 patients with good results.
The facial features of Orientals and Caucasians are different in many respects. In Orientals, the concept of beauty differs in each country depending on the cultural background. At present time, blepharoplasty in the Oriental eye is the most common aesthetic procedure performed in Korea and Japan. The objective should not be the caucasianization of the Oriental eye, where desired modifications are usually quite subtle. Generally, patients prefer more defined and invaginated folds, but not necessarily a very high fold, since the latter will often look unnatural or overdone in the Oriental face. We have found several different types of eyelids in the Oriental population. The purpose of this presentation is to present our nonincision technique to create aesthetically pleasing supratarsal folds. Seven-hundred and sixty-two patients were reviewed. We have found that our single-suture method is very reliable and allows the construction of a more even, smooth, and symmetrical fold.
A prominent mandibular angle is considered to be unattractive in the Orient because it gives the face a square and muscular appearance. While described infrequently in the United States, this entity is commonly encountered in the Orient owing to different facial characteristics and different aesthetic sensibilities. We present a retrospective study of 42 female patients who presented requesting the reduction of a prominent mandibular angle for cosmetic reasons. We describe our approach, which utilizes formal planimetry, cephalometric tracings, and Panorex mandibular radiographs. We utilize the intraoral approach and use an oscillating saw to resect the predetermined segment of bone. In 18 of the 42 patients, we resected muscle as well. We also describe using the preauricular incision in a patient undergoing a concomitant rhytidectomy. Our cosmetic results have been generally satisfactory, with only one inaccurate osteotomy. We had three infections which resolved without sequelae.
The authors have studied the effects of various circulatory settings on flap survival. The dog model was used to study the survival of venous flaps without arterial inflow both as island and free flaps. Venous flaps were compared with arterial flaps without venous outflow and standard island flaps with arterial inflow and venous outflow. Attempts were made to study their vascular morphology and blood gas changes. The venous flaps without arterial inflow survived with normal hair growth and wound healing, as did the standard island flaps. These observations suggest that capillary diffusion can occur without the continuous flow of blood through a capillary. Several possible mechanisms to explain survival of the venous flaps without arterial inflow were discussed. These observations could be important in providing an animal model to study microcirculation and a possible new area for microsurgical transfer of a skin flap.
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NC 7197, a new N-substituted tetrahydroisoquinoline derivative, was given in doses of 0.2 mg/kg body weight on 26 occasions to a series of 23 critically ill postoperative and posttraumatic patients who had been in moderate or severe degrees of shock. This agent was observed to improve pressure-flow and oxygen-transport variables, including increases in cardiac index, mean arterial pressure, central venous pressure, both left and right ventricular stroke work, central blood volume, systemic vascular resistance, oxygen availability, arteriovenous oxygen content difference, and oxygen consumption, and decreases in mean transit time and pulmonary vascular resistance. Previous studies on critically ill patients have suggested that these are the most commonly desired therapeutic actions for this type of patient. The agent has pronounced inotropic effect with minimal chronotropic effects, but with higher doses, chronotropic effects as well as alpha blocking effects may occur. The optimal effects may be obtained by adjusting the dose to an appropriate therapeutic range. It is concluded that, in the dose used, this agent produced both alpha and beta adrenergic actions in critically ill patients.
There was no correlation of blood volume measurements with central venous pressure (CVP) or hematocrit determinations and only minimal suggestive trends with wedge pressure in a large series of postoperative patients; the lack of correlations emphasize the unreliability of venous pressure and hematocrit determinations to predict blood volume alterations. To evaluate the physiological problems, to define optimal therapeutic goals, and to measure therapeutic effectiveness of volume loading with an oncotically active agent, we measured the hemodynamic and oxygen transport responses to 500 ml. of 5 percent albumin given over 1 hour in 22 patients with CVP greater than 15 cm. H2O. The patients were separated into two groups according to the CVP response to volume therapy. The CVP decreased in 14 (64 percent) of these patients (Group 1), but it increased slightly but not significantly in eight (36 percent) patients (Group 2). In Group 1 patients, there was increased flow, improvement of tissue perfusion as reflected by increased oxygen consumption, and augmentation of the ventricular function. In Group 2 there were slight increases in mean flow, mean pulmonary arterial pressure, and mean transit time and slightly decreased pulmonary vascular resistance; there was appreciable improvement in left ventricular function without significant deterioration of right ventricular function. The high initial central venous pressure is not a reliable index of either hypervolemia or cardiac failure in critically ill patients. It is concluded that a trial of volume loading with an oncotically active agent with frequent auscultation of the chest and careful observation of the CVP trends will give the maximum diagnostic as well as therapeutic information.
Sequential changes in renal function were studied in a series of 114 postoperative patients who developed acute renal failure. The loss of concentrating ability, manifest by a change from strongly negative free-water clearances to values near zero, occurred 24 to 48 hours before the onset of blood urea nitrogen (BUN) and creatinine elevations. In 15 patients a transient period of positive free-water clearance was documented just before these values approached zero. Criteria were proposed for early diagnosis of acute renal failure (ARF) based upon description of the temporal pattern of free-water clearance values. The loss of concentration ability occurred with decreased urinary Na+ concentration unless patients were given large amounts of saline solution prior to the development of ARF. This was followed by gradually increasing urinary Na+ concentrations. Changes in K+ concentrations were not significant until the late stage of renal failure. Recovery patterns in 46 of these patients who survived demonstrated an early return of negative free-water clearance followed by gradually decreasing BUN and serum creatinine values. During this period recovery of the ability of Na reabsorption and excretion of K+ was indicated by decreased urinary Na+ concentrations and increased urinary K+ concentrations.
In a series of 114 consecutive patients with acute renal failure, the over-all mortality rate was 60 per cent; 62 per cent of the patients had a documented episode of hypotension just prior to the development of acute renal failure. In 11 patients, a second episode of renal failure developed following recovery from the initial episode of acute renal failure; all of these patients died. The urine output rate during the course of acute renal failure was inversely related to the mortality rate in the series as a whole. The mean duration of acute renal failure in survivors of the present series was 11.0 plus or minus 1.4 days. Complications of renal failure in the order of their frequency included hemorrhagic hypotension, sepsis, sepsis with hypotension and consumption coagulopathies; only 12 per cent had no complications. Only six of 51 patients whose clinical course was complicated by sepsis with or without an episode of hypotension survived. By contrast, 30 of 53 patients who had hemorrhagic hypotension without sepsis survived. The date suggest that although acute renal failure has a high mortality rate, it is a benign disease that is potentially reversible. Regardless of age and sex, renal functional recovery will take place if the patient is maintained in good physiologic condition long enough without a continued stress, such as sepsis, hypotension or hypovolemia, all of which prolong renal ischemia. During the course of renal failure, extreme care is essential to maintain adequate circulating volume without extracellular fluid overload; a second hemodynamic insult may result in serious damage to the regenerating renal tubules. We conclude that early recognition of acute renal failure, aggressive management of sepsis, careful titration of fluid and electrolyte therapy, meticulous monitoring, maintenance of the circulation and judicious utilization of dialysis will aid in reduction of mortality in these critically ill patients.
The influence of hypertonic glucose with and without added amino acids was studied in 129 consecutive postoperative patients with acute renal failure. The addition of amino acids was associated with lower mortality and morbidity rates in the patients who received dialysis as well as in those who did not. There was no significant differences in the blood urea nitrogen levels of the two groups. The incidence of hyperkalemia and the rise in plasma osmolality were less in the group given adequate calories and amino acids.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
The anatomy, design, and blood supply of the pectoralis major myocutaneous island flap are described. This versatile, nondelayed flap has, for the most part, replaced the usual cutaneous flaps. Clinical examples of its use in head and neck reconstructive surgery are presented.
Ten or nine-digit amputation is a very rare injury. From March, 1987 to June, 1988, we replanted two cases of ten-digit complete amputation and two cases of nine-digit complete amputation with success. The maximum ischaemic time was 39 h and the operation time was between 25 and 31 h. All digits survived completely except for partial necrosis of one finger. The follow-up has been 13-20 months, and all the patients have a pair of good, functional and aesthetically acceptable hands.