<p style="text-align: justify;">BACKGROUND: The coverage of soft tissue defects of the distal leg, ankle or foot poses several challenges to the reconstructive surgeon. Reconstructive procedures may range from simple skin grafting to complicated free tissue transfers. The reverse sural flap has been one of the most dependable methods for soft tissue coverage of such complex wounds. The purpose of this paper was to compare the clinical results of reverse sural flaps harvested with a fascial versus a fasciocutaneous pedicle.p> <p style="text-align: justify;">METHODS: A retrospective cohort of twenty-six patients who underwent a reverse sural flap procedure for complex wounds of the distal lower extremity was examined from January 1, 2003 to December 31, 2009, with a minimum follow-up of one month. Fifteen patients had a fascial pedicled flap, while eleven patients had fasciocutaneous pedicled flaps with a minimum of one month follow-up. The primary outcome was flap-related complications. Fisher's exact test was used to determine the differences between the two groups and the level of significance was set at p?0.05.p> <p style="text-align: justify;">RESULTS: All flaps survived. Flap-related complications were more common in the fascial pedicled flap (6/15) compared with the fasciocutaneous pedicled flap (1/11). The difference was not significant (p=0.09). In terms of cosmetic acceptability, 11 patients (11/15) in the fascial pedicle group and five patients (5/11) in the fasciocutaneous pedicle group expressed that the sural flap was acceptable.p> <p style="text-align: justify;">CONCLUSION: Reverse sural flap was a reliable reconstructive procedure for coverage of soft tissue defects of the distal leg, ankle or foot. There was no significant difference in terms of complication rates for those with fascial compared with those with fasciocutaneous flaps. Cosmetic acceptability was higher for the fascial pedicled flap.p>
Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Ankle ; Skin Transplantation ; Surgical Flaps ; Foot ; Reconstructive Surgical Procedures ; Fascia ; Surgeons

<p style="text-align: justify;">OBJECTIVES: The primary objective of this study was to define the anatomy of the musculocutaneous nerve as it innervates the biceps and brachialis muscles in relation to nerve transfer surgery in brachial plexus injury.p><p style="text-align: justify;">METHODS: Surgical dissection of the musculocutaneous nerve of both upper extremities of 34 embalmed cadavers was performed to define the anatomy of the musculocutaneous nerve as it supplies the biceps and the brachial muscles. Among the data that we noted were the distance where the branch of the biceps and branchialis took off from the musculocutaneous nerve from the coracoids, which was the bony landmark.p><p style="text-align: justify;">RESULTS: There were 17 males and 17 females with a total of 65 musculocutaneous nerve to biceps muscle had an average distance of 10.9cm and a median of 11.0cm±1.83cm (range, 6.5-14.2 cm) from the coracoid. The branching of musculocutaneous nerve to the brachialis had an average distance of 15.1 cm and a median 15.5cm±1.72cm (range, 12.7-21.0cm) from the coracoid. Transferring the fascicles of the ulnar nerve to the biceps branch and a fascicle of the median nerve to the brachialis branch is fairly easy since both nerves are within the vicinity of respective recipient site.p><p style="text-align: justify;">CONCLUSION: The anatomy of the musculocutaneous nerve as it supplies the elbow flexors is fairly consistent and there is little discrepancy between cadaveric specimens. Human ; Male ; Female ; Musculocutaneous Nerve ; Ulnar Nerve ; Median Nerve ; Elbow ; Nerve Transfer ; Elbow Joint ; Brachial Plexus ; Embalming ; Cadaver

<p style="text-align: justify;">We present a case of an 8-year-old girl with a high grade osteogenic sarcoma of the proximal humerus treated with wide resection and vascularized proximal humerus treated with wide resection and vascularized proximal fibular epiphyseal transfer. At 5 years after reconstruction, the patient is tumor free and had a Musculoskeletal Tumor Score of 26/30 or 86.7%. The functional outcomes in terms of shoulder range of motion and pain were good. Complications include transient peroneal nerve palsy and mild valgus instability of the knee.p>
Human ; Female ; Child ; Shoulder ; Peroneal Nerve ; Range Of Motion, Articular ; Fibula ; Humerus ; Knee Joint ; Pain ; Osteosarcoma

Introduction: This study aimed to determine the prevalence of malnutrition and factors influencing malnutrition among children aged five years and below in Serian District of Sarawak, a district where the majority of people are indigenous. Methods: Using a cross-sectional method, a total of 177 children were randomly selected and assessed, and their mothers or caregivers were interviewed. Data were collected using a pretested questionnaire; anthropometric measurements were also taken. Data were analysed using SPSS version 17.0. Results: The prevalence of underweight, stunting and wasting in children aged five years and below was 20.9%, 11.9% and 10.2% respectively. The results suggest that the significant factors contributing to underweight are birth weight, frequency of child visit to the clinic, and individual insecurity. Only age, when complementary diet was introduced, was found to be significantly associated with stunting. For wasting, individual insecurity, duration of family planning and met recommended protein intake per day were found to be significant factors. Conclusion: The prevalence of malnutrition in children 5 years and below in Serian District of Sarawak is high compared to state figures. The major contributing factors were found to be manifested at the individual and family level. There is a need for appropriate public health promotion and socioeconomic improvement interventions towards improving the nutritional status and health of children in Serian District.
Child Nutrition Disorders, Malnutrition ; Thinness

Adolescent ; Adult ; Asthma ; drug therapy ; Czechoslovakia ; History of Medicine ; Humans ; Injections, Subcutaneous ; Isoquinolines ; administration & dosage ; Mental Disorders ; drug therapy ; Psychiatry ; history ; Terbutaline ; administration & dosage ; therapeutic use ; Tranquilizing Agents ; history ; therapeutic use ; Tretoquinol ; administration & dosage ; therapeutic use

Asthma ; drug therapy ; epidemiology ; physiopathology ; prevention & control ; Humans ; Pediatrics ; Singapore ; epidemiology

Magnetic Resonance-guided focused Ultrasound Surgery (MRgFUS) is gaining popularity as an alternative to medical and surgical interventions in the management of symptomatic uterine fibroids. Studies have shown that it is an effective non-invasive treatment with minimal associated risks as compared to myomectomy and hysterectomy. MRgFUS can be offered to a majority of patients suffering from symptomatic uterine fibroids. It has been suggested that the use of broader inclusion criteria as well as the mitigation techniques makes it possible to offer MRgFUS to a much larger subset of patients than previously believed. This paper will describe how MRgFUS treatment for uterine fibroids is performed at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

Antioxidants oppose the toxic actions of lipid peroxides and oxygen radicals, and they limit the amount of lipid peroxides formed. Women with normal pregnancies have an increase in oxidative stress and lipid peroxidation when compared with nonpregnant women. The antioxidants also increase progressively with advancing gestation, and the antioxidants in the fetus also increase with advancing gestation, especially during late gestation. The purpose of this study is to investigate the diefference of antioxidant status in maternal and neonatal plasma according to the delivery type. So, we investigated the status of antioxidant in the maternal and neonatal plasma when compared normal vaginal delivery with Cesarian section without labor. This study was done under the hypothesis that labor pain is originated from the hypoxic state of myometrium during uterine contraction. The number of women who were studied was total 56, 24 women were delivered by normal vaginal delivery and 32 women were done by Cesarean section without labor. The blood was sampled during active labor and postpartum 24 hour in the case of normal vaginal delivery, the women who were done Cesarean section being sampled before operation and 24 hours after operation. The neonatal blood was sampled from cord, birth 1 day and 3 day. The antioxidant levels were measured by Total Antioxidant Status (Randox Laboratory Ltd., UK) kit. The results were as follows. 1. The mean maternal plasma antioxidant status was not significantly different according to delivery types and not significantly different when compared antepartum with postpartum (vaginal delivery; antepartum: 1.54+/-0.31 mM/L, postpartum: 1.58+/-0.32 mM/L, Cesarean section; antepartum: 1.55+/-0.29 mM/L, postpartum: 1.56+/-0.33 mM/L). 2. The neonatal antioxidant status was not significantly different between the neonates who were born by vaginal delivery and the neonates who were born by Cesarean section. The neonatal plasma antioxidant status was increased progressively after birth (cord: birth 1 day: birth 3 day=1.46+/-0.25 mM/L: 1.59+/-0.25 mM/L: 1.79+/-0.37 mM/L). Therefore, labor pain was not seems to be significantly affect the maternal and neonatal plasma antioxidant status. And the neonatal antioxidant status was increased for adaptation to the external environment after birth.
Animals ; Antioxidants ; Cesarean Section ; Female ; Fetus ; Humans ; Infant, Newborn ; Labor Pain ; Lipid Peroxidation ; Lipid Peroxides ; Mice ; Myometrium ; Oxidative Stress ; Parturition ; Plasma* ; Postpartum Period ; Pregnancy ; Reactive Oxygen Species ; Toxic Actions ; Uterine Contraction

BACKGROUND: Overweight, obesity, and cardiovascular disease risk factors are prevalent among firefighters in some developed countries. It is unclear whether physical activity and cardiopulmonary fitness reduce cardiovascular disease risk and the cardiovascular workload at work in firefighters. The present study investigated the relationship between leisure-time physical activity, cardiopulmonary fitness, cardiovascular disease risk factors, and cardiovascular workload at work in firefighters in Hong Kong. METHODS: Male firefighters (n = 387) were randomly selected from serving firefighters in Hong Kong (n = 5,370) for the assessment of cardiovascular disease risk factors (obesity, hypertension, diabetes mellitus, dyslipidemia, smoking, known cardiovascular diseases). One-third (Target Group) were randomly selected for the assessment of off-duty leisure-time physical activity using the short version of the International Physical Activity Questionnaire. Maximal oxygen uptake was assessed, as well as cardiovascular workload using heart rate monitoring for each firefighter for four "normal" 24-hour working shifts and during real-situation simulated scenarios. RESULTS: Overall, 33.9% of the firefighters had at least two cardiovascular disease risk factors. In the Target Group, firefighters who had higher leisure-time physical activity had a lower resting heart rate and a lower average working heart rate, and spent a smaller proportion of time working at a moderateintensity cardiovascular workload. Firefighters who had moderate aerobic fitness and high leisuretime physical activity had a lower peak working heart rate during the mountain rescue scenario compared with firefighters who had low leisure-time physical activities. CONCLUSION: Leisure-time physical activity conferred significant benefits during job tasks of moderate cardiovascular workload in firefighters in Hong Kong.
Cardiovascular Diseases ; Developed Countries ; Diabetes Mellitus ; Dyslipidemias ; Firefighters* ; Heart Rate ; Hong Kong ; Humans ; Hypertension ; Leisure Activities* ; Male ; Motor Activity* ; Obesity ; Overweight ; Oxygen ; Risk Factors* ; Smoke ; Smoking

<p>AIMTo determine the long-term outcome, effectiveness and patient satisfaction of congenital penile curvature correction by plication of tunica albuginea.p><p>METHODSFrom January 1992 to January 2002, 106 young patients underwent surgical correction of congenital penile curvature by corporeal plication. Indications for operation were difficult or impossible vaginal penetration and cosmetic problems. The technique of corporeal plication consists of placing longitudinal plication sutures of 2-zero braided polyester on the convex side of the curvature until the curvature is corrected when erection is artificially induced. Results of this procedure were obtained by retrospective chart reviews and questionnaires via mail. Long-term follow-up ranged from 11 to 132 (mean 69.3) months and data were available for 68 patients.p><p>RESULTSPenile straightening was excellent in 62 patients (91 %) and good with less than 15 degree of residual curvature in 6 patients (9 %). Sixty-seven patients reported no change in erectile rigidity or maintenance postoperatively, while 1 described early detumescence. Shortening of the penis without functional problems was noted by 26 patients (38 %). Thirty-Five patients (51 %) reported feeling palpable indurations (suture knots) on the penis. Temporary numbness of glans penis was described in 3 patients. Overall, 60 patients were very satisfied, 6 satisfied, 2 unsatisfied.p><p>CONCLUSIONCorporeal plication is an effective and durable procedure with a high rate of patient satisfaction.p>
Adolescent ; Adult ; Follow-Up Studies ; Humans ; Male ; Penile Erection ; Penis ; abnormalities ; surgery ; Retrospective Studies ; Surgical Procedures, Operative ; Treatment Outcome