The treatment of extensive soft tissue injury of lower extremities is known to be one difficulty in the field of orthopedic surgery. At present, reconstructive surgery with free flap is being employed under the microscopy actively. But the size of defect is found larger than the maximum size of one free flap frequently. The authors present 6 cases of a combined scapular flap and latissimus dorsi flap for extensive soft tissue injury of the lower extremities at the department of orthopedic surgery of Severance hospital, during years period from 1983 to 1985. The results of the study are as follow: l. A one stage reconstruction of extensive soft tissue injury was done with a combined scapular flap and latissimus dorsi flap. 2. In spite ofa few complications of donor and recipient sites, the advantage of combined scapular flap and latissimus dorsi flap exceed the any methods that have been employed in functional and plastic aspects. 3. There was no limitation of motion of the shoulder in spite of the excision of the large combined scapular flap and latissimus dorsi flap around the axillary area. 4. The primary closure of the donor sites was feasible. 5. The reconstructive surgery of the extensive soft tissue injury using the above combined scapular flap and latissimus dorsi flap can be used without restriction as to the age of the patient.
Free Tissue Flaps ; Humans ; Lower Extremity ; Microscopy ; Orthopedics ; Plastics ; Shoulder ; Soft Tissue Injuries ; Superficial Back Muscles ; Tissue Donors

Distraction osteogenesis techniques have provided more than a clinical treatment of limb length discrepancies and bone deformities. The nature of this mechanical environment and the characteristics of the regenerate bone are not typical of that found elsewhere in the skeleton. The purposes of this study were to investigate the physical and mechanical properties of regenerate bone in different consolidation period (sacrificing at the period of 8, 12, 18, 20, 24, 26 weeks post surgery) and to find out the relationship between both properties. Two ring Ilizarov fixators were applied to the right tibia in 7 large, skeletally mature dogs. A subperiosteal osteotomy of tibia was performed. Postoperatively, after 7 days of latency period, distraction was begun. Distraction of 1mm daily, 3 times per day was continued until radiographic evidence of a 2.5 cm distraction. Sacrifice was at 8, 12, 18, 20, 22, 24, 26 weeks post surgery. Allof the specimens were obtained from regenerate bone and were cutted in the rectangular shape of approximately 8x4x4 mm. Specimens were tested in axial compression and displayed an average modulus of elasticity of 215(sd=184)Mpa, an average yield stress of 3.58(sd=2.54)MPa, an average apparent bone density of 0.399(sd=0.107)g/cc, and an average ash weight density of 0.164(sd=0.084)g/cc. A linear regression of yield stress on modulus of elasticity was significant(p < 0.001) with R-square=0.28, and a slope of 0.007. The radiographic bone densitometry was performed before sacrifice. The results of densitometry of regenerate bone was osteoporotic comparing with those of the opposite tibia which did not be operated in all of the animals. The linear regressions of mechanical properties on physical properties were significant, only 12-34% of the variance in mechanical properties could be explained by the physical properties. In conclusion, based on the observation of the low ash fraction, it would be expected that the relationship between physical properties and mechanical properties may not be strong. This study suggested that the regenerate bone was a composite of bone and non-mineralized tissue until 26 weeks of post surgery. For the more accurate information of material property, testing of real regenerate bone without non-mineralized bone may be necessary.
Animals ; Bone Density ; Congenital Abnormalities ; Densitometry ; Dogs ; Elastic Modulus ; Extremities ; Latency Period (Psychology) ; Linear Models ; Osteogenesis, Distraction ; Osteotomy ; Skeleton ; Tibia

Objective: Conflicting results regarding SOX17 genes and the risk of intracranial aneurysms (IA) exist in the Korean population, although significant positive correlations were noted in genome-wide association studies in European and Japanese populations. Therefore, we aimed to investigate an association between SOX17 gene variants and IA using exome sequencing data. Methods: This study included 26 age-gender matched IA patients and 26 control subjects. The SOX17 gene variants identified from whole-exome sequencing data were examined. Genetic associations to estimate odds ratio (OR) and 95% confidence interval (CI) were performed using the software EPACTS. Results: The mean age of the IA and control groups were 51.0±9.3 years and 49.4±14.3 years, respectively (p=0.623). Seven variants of SOX17, including six single nucleotide polymorphisms and one insertion and deletion, were observed. Among these variants, rs12544958 (A>G) showed the most association with IA, but the association was not statistically significant (OR, 1.97; 95% CI, 0.81-4.74; p=0.125). Minor allele frequencies of the IA patients and controls were 0.788 and 0.653, respectively. None of the remaining variants were significantly associated with IA formation. Conclusion No significant association between SOX17 gene variants and IA were noted in the Korean population. A large-scale exome sequencing study is necessary to investigate any Korean-specific genetic susceptibility to IA.

BACKGROUND: Adipose tissues were initially introduced as energy storages, but recently they have become famous as an endocrine organ which produces and secretes various kinds of molecules to make physiologic and metabolic changes in human body. It has been studied that these molecules are secreted in abundance as the adipose tissue becomes bigger along with obesity. Furthermore, it has been found that they are mediating systemic inflammation and generation of metabolic diseases such as type 2 diabetes and atherosclerosis. On the basis of these, we studied previous papers which have been researched about the interaction between preadipocytes and macrophages, adipose tissues and lymph nodes, and adipose tissue secreting molecules. RESULTS: Firstly, preadipocytes and macrophages are expressing similar transcriptomes and proteins, and preadipocytes can be converted to mature macrophages which have phagocytic activity. Moreover, the monocytes, which initially located in the bone marrow, are filtrated to the adipose tissue by monocyte chemotatic protein-1 and are matured to macrophages by colony stimulating factor-1. Secondly, adipose tissues and their associated lymph nodes are interacting each other in terms of energy efficiency. Lymph nodes promote lipolysis in adipose tissues, and polyunsaturated fatty acids in adipocytes become energy sources for dendritic cells. Lastly, adipose tissues produce and secrete proinflammatory molecules such as leptin, adiponectin, TNF-alpha, IL-6, and acute phase proteins, which induce the inflammation and potentially generate metabolic diseases. CONCLUSION: According to these, we can link adipose tissues to inflammation, but we need to affirm the actual levels and roles of adipose tissue-derived proinflammatory molecules in human body.
Acute-Phase Proteins ; Adipocytes ; Adiponectin ; Adipose Tissue* ; Atherosclerosis ; Bone Marrow ; Dendritic Cells ; Fatty Acids, Unsaturated ; Human Body ; Immune System* ; Inflammation ; Interleukin-6 ; Leptin ; Lipolysis ; Lymph Nodes ; Macrophages ; Metabolic Diseases ; Monocytes ; Negotiating ; Obesity ; Transcriptome ; Tumor Necrosis Factor-alpha

Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to interact with the oral anticoagulant warfarin and can cause a serious bleeding complication. In this study, we evaluated the risk factors for international normalized ratio (INR) increase, which is a surrogate marker of bleeding, after addition of an NSAID in a total of 98 patients who used warfarin. Patient age, sex, body mass index, maintenance warfarin dose, baseline INR, coadministered medications, underlying diseases, and liver and kidney functions were evaluated for possible risk factors with INR increase > or =15.0% as the primary end-point. Of the 98 patients, 39 (39.8%) showed an INR elevation of > or =15.0% after adding a NSAID to warfarin therapy. Multivariate analysis showed that high maintenance dose (>40 mg/week) of warfarin (P=0.001), the presence of coadministered medications (P=0.024), the use of meloxicam (P=0.025) and low baseline INR value (P=0.03) were the risk factors for INR increase in respect to NSAID-warfarin interaction. In conclusion, special caution is required when an NSAID is administered to warfarin users if patients are taking warfarin >40 mg/week and other medications interacting with warfarin.
Adult ; Aged ; *Anti-Inflammatory Agents, Non-Steroidal/adverse effects/therapeutic use ; *Anticoagulants/adverse effects/therapeutic use ; Drug Interactions ; Female ; Hemorrhage/*chemically induced ; Humans ; International Normalized Ratio ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thiazines/adverse effects/therapeutic use ; Thiazoles/adverse effects/therapeutic use ; *Warfarin/adverse effects/therapeutic use

Odontogenic keratocysts are benign intraosseous tumors of odontogenic origin that occur most commonly in the jaw. In particular, they have a predilection for the angle and ascending ramus of the mandible. In contrast, odontogenic keratocysts arising in the maxillary sinus are relatively rare. Two such cases are reported herein. In addition, the English literature that concerns odontogenic keratocysts of the maxillary sinus is reviewed.
Jaw ; Mandible ; Maxillary Sinus ; Odontogenic Cysts ; Tooth

Although the mechanism of hemifacial spasm (HFS) is not yet well established, vascular compression of the facial nerve root exit zone and hyperexcitability of the facial nucleus have been suggested. We report a case of HFS in the setting of coinciding intracranial hemorrhage (ICH) of the pons and proximal ligation of the contralateral vertebral artery (VA) for the treatment of a fusiform aneurysm of the distal VA and discuss the possible etiologies of HFS in this patient. A 51-year-old male with an ICH of the pons was admitted to our hospital. Neuroimaging studies revealed an incidental fusiform aneurysm of the right VA distal to the origin of the posterior inferior cerebellar artery. Eight months after proximal ligation of the VA the patient presented with intermittent spasm of the left side of his face. Pre- and post-ligation magnetic resonance angiography revealed an enlarged diameter of the VA. The spasm completely disappeared after microvascular decompression.
Aneurysm ; Arteries ; Decompression ; Facial Nerve ; Hemifacial Spasm ; Hemodynamics ; Humans ; Intracranial Hemorrhages ; Ligation ; Magnetic Resonance Angiography ; Male ; Microvascular Decompression Surgery ; Middle Aged ; Neuroimaging ; Pons ; Spasm ; Vertebral Artery

A 61-year-old woman visited our hospital for bilateral multiple lung nodules and a mass in her thorax. She had a long history of multiple metastatic recurrences of solid pseudopapillary neoplasm (SPN); 24 years previously, the patient had undergone pylorus-preserving pancreaticoduodenectomy for a 9.9 × 8.6 cm mass in the pancreatic head. The tumor was diagnosed as an SPN. Nine years later, metastatic nodules were found on computed tomography in the patient's liver and peritoneum and were excised. She subsequently underwent an additional eight metastatectomy procedures in diverse organs. For the presented event, the lung nodules were removed. The prevalence of malignant SPN in the general population is 5%–15%. However, multiple metastatic recurrence of malignant SPN is rare; the lung is a particularly rare site of metastasis, found in only three cases in the literature. Here, we describe this exceptional case and provide a literature review.
Female ; Head ; Humans ; Liver ; Lung ; Middle Aged ; Neoplasm Metastasis ; Pancreas* ; Pancreaticoduodenectomy ; Peritoneum ; Prevalence ; Recurrence ; Thorax

BACKGROUNDS: Ischemic heart diseases has increased by more than 80% in the past 10 years among Korean and the global risk assessment of coronary heart disease(CHD) based on the relative risk factors to the probability of developing CHD became widely used for western populations. In this study we hope to provide information on the distribution and characteristics of the relative risks of CHD using the Framingham risk score. METHODS: This Study involved the subjects who visited a university hospital for health promotion from 1995 to 2000 without CHD. We surveyed medical history of the subjects, and measured their blood pressure, serum glucose, total cholesterol(total C) and HDL cholesterol(HDL C). Risk points from the Framingham chart were given to age, systolic BP, total C, HDL C, smoking, diabetes, and the global risk score was calculated from their sum. We analyzed the global risk scores and each risk points of the high risk groups. RESULTS: For younger and older men in the high risk group, the factors smoking and high blood pressure had the highest score assigned respectively. With younger women total C had the highest score assigned, and with older women diabetes took over but HDL C and high blood pressure still had a higher score. CONCLUSION: For primary prevention of CHD, younger men need active education to quit smoking and for older aggressive blood pressure control is desperately needed. For women, concern about low HDL C is highly needed and after menopause aggressive treatment for diabetes, high blood pressure, low HDL C is needed.
Blood Glucose ; Blood Pressure ; Coronary Disease* ; Education ; Female ; Health Promotion ; Heart ; Hope ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Menopause ; Myocardial Ischemia ; Primary Prevention ; Risk Assessment ; Risk Factors* ; Smoke ; Smoking

Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of gastrointestinal bleeding. The diagnosis of PAEF is difficult to make. The classic triad of symptoms, i.e. gastrointestinal bleeding, abdominal pain, and a pulsating abdominal mass is overemphasized, as it occurs in less than 11~25% of the patients. For two thirds of the patients, the diagnosis is made in the operating room. Endoscopic and radiographic studies are very helpful, but the absence of abnormalities can not exclude the diagnosis. PAEF is a clinical and surgical challenge associated with high mortality. A high index of suspicion, early diagnosis and prompt and appropriate surgical intervention are essential to patient survival. Two primary aortoenteric fistulas (aortoduodenal and aortoesophageal) cases are presented and the related literature are reviewed.
Abdominal Pain ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal ; Early Diagnosis ; Fistula ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Intestinal Fistula ; Operating Rooms ; Vascular Fistula