The pedicled fillet flap concept has been successfully applied in both the upper and lower extremities for the treatment of difficult wound. In cases of inevitable extremity amputation, the transfer of pedicled flap from the amputed part is possible. In such substance, it is possible to obtain the pedicled fillet flap from the amputed limb to provide stump coverage. We experienced two cases of below-knee amputation due to severe flame burn which the stump was covered with island pedicled sole-fillet flap.
Amputation Stumps* ; Amputation* ; Burns ; Extremities ; Knee* ; Lower Extremity ; Surgical Flaps ; Wounds and Injuries

It is indispensable to cover the skin defect when bone or tendon is exposed. In case of inevitable amputation of an extremity, it is possible to harvest a free flap from the amputed limb for providing coverage of the other wound. This technique allows immediate wound coverage without the morbidity of an additional donor site. We experienced an electrical burn case with inevitahle wrist disarticulation and successfully treated soft tissue defect of ankle using free vascularized flap.
Amputation ; Ankle* ; Burns ; Disarticulation ; Extremities ; Free Tissue Flaps ; Hand* ; Humans ; Skin ; Tendons ; Tissue Donors ; Wounds and Injuries ; Wrist

PURPOSE: The purpose of this study is to evaluate that sequential CT scans after oral contrast ingestion can show morphological and functional status of the biliary tree, especially for the gallbladder and assess whether the CT scans demonstrate other radiological informations than conventional oral cholecystography. MATERIALS AND METHODS: Thirty volunteers in third decades and eight patients with hepatobiliary disease were included for the study. CT scans were obtained 3, 6, 9, 12 hours after oral contrast ingestion and thirty minutes after fat meal in thiry volunteers. Conventional oral cholecystography was also obtained in all volunteers at 12 hours after oral contrast ingestion and after fat meal. We evaluate opacification of gallbladder, biliary tree, and duodenum by contrast media on CT scans and attenuation values of gallbladder, common hepatic duct and common bile duct in each artatomic area on CT and its sequential change. CT scans were performed 6 hours after oral contrast ingestion in eight patients with hepatobiliary disease. And gallbladder function was evaluated by opacification of gallbladder by contrast media in all patients. RESULTS: In thirty volunteers, opacified gallbladder by contrast media was seen in all cases in all sequential periods of time on CT scans, but in 22 cases on conventional oral cholecystography. Contrast-filled intrahepatic ducts were demonstrated in 3 cases at 3 hours after oral contrast ingestion and 11 cases at 6 hours and were not seen thereafter. Contrast-filled common hepatic duct was noted in 28, 18 and 4 cases respectively at 3, 6 and 9 hours after oral contrast ingestion and the CT attenuation values of common hepatic ducts had become progressively decreased. Contrast-filled common bile duct was noted in 28, 18 and 4 cases respectively at 3, 6 and 9 hours and the CT attenuation values of common bile ducts were not changed untill 9 hours but slightly increased at 12 hours. Contrast media was noted in 7, 5, 6 and 5 cases at 3, 6, 9, and 12 hours in cystic duct and 8, 3, 2, 5 cases in duodenum. Contrast-filled cystic duct and duodenum were noted in 24 cases and 19 cases respectively on CT scans after fat meal. The CT attenuation values of gallbladder were increased in sequential periods of time and the difference of density of gallbladder between 3 hours and 6 hours was statistically significant(p=0.0001). The CT attenuation values of gallbladder at 6 hours were heighter than that in 3 hours, statistically. Opacified gallbladder were noted in 2 cases of fatty liver(n=2), 1 case of alcoholic liver disease(n=1), in 1 case of liver cirrhosis(n=1). Patients of gallbladder stone(n=2) or hepatocellular carcinoma (n=2) had non-opacified gallbladder on CT scans. CONCLUSION: The CT scans after oral contrast ingestion can show the morphological and functional aspects of gallbladder better than conventional oral cholecystography and can also show biliary trees and other surrounding structures, so it is helpful method for assessment of not only gallbladder diseases but also other hepatobiliary diseases.
Alcoholics ; Bile Ducts* ; Bile* ; Biliary Tract ; Carcinoma, Hepatocellular ; Cholecystography ; Common Bile Duct ; Contrast Media ; Cystic Duct ; Duodenum ; Eating* ; Gallbladder Diseases ; Gallbladder* ; Hepatic Duct, Common ; Humans ; Liver ; Meals ; Tomography, X-Ray Computed ; Volunteers

No abstract available.
Cutaneous Fistula ; Fistula*

Lipoprotein(a) [Lp(a)] is considered an additional, independent and largely genetically determined risk factor for the development of premature coronary heart disease. Furthermore abnormal plasma lipoprotein patterns have been associated with increased risk for developing coronary heart disease. Among these lipoproteins, an increased concentration of serum Apo B and decreased level of Apo A are considered as major risk factors. together with elevated serum cholesterol and decreased HDL cholesterol. The aim of this study is to assess serum Lp(a) levels in newborns and to observe their evolution between brith, 7 days and 1 month in 64 healthy newborns by using ELISA method, Other lipid profiles were also measured and compared with feeding formula methods. The results obtained were as follows: 1) There were no significant changes from birth to 7 days, but was increased significantly after 7 days to 1 month of serum Lp(a) concentrations. 2) There were dramatic increases between birth and 7 days for Apo B and did not change between 7 days and 1 month, while Apo A-I was already present in significant levels at birth and was changed continuously between 7 days and 1 month. 3) There were marked increases between birth and 7 days for total cholesterol and triglycerides, while after 7 days the cholesterol levels only progressively increased until month. 4) There were continuous increases between birth and 7 days and 1 month for HDL-C, while LDL-C was markedly increased between birth and 7 days. 5) There were no significant correlations between serum Lp(a)concentrations and other lipid profiles neither age, sex and feeding formulas. In conclusion, our data suggest that the adequate timing for the screening test of Lp(a) in newborns is around 1 month after birth and there are no statistically significant correlations between Lp(a) and other lipid profiles.
Apolipoprotein A-I ; Apolipoproteins B ; Cholesterol ; Cholesterol, HDL ; Coronary Disease ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infant, Newborn* ; Lipoprotein(a)* ; Lipoproteins ; Mass Screening ; Parturition ; Plasma ; Risk Factors ; Triglycerides

Isolated and severe left main coronary ostial stenosis is a rare case. In the majority of these patients ostial stenosis was associated with any of the conditions known to involve the coronary ostia. These conditions include syphilitic aortitis, Takayasu's aortitis, familial hypercholesterolemia, and aortic valve disease. A 34-year young female patient was presented with exertional and stabbing anterior chest pain. There was no history of syphilis, diabetes mellitus, hypertension, hyperlipidemia and smoking. Coronary angiogram showed isolated left main coronary ostial stenosis. Transesophageal echocardiography(TEE) showed acute angle takeoff of the left main coronary artery. She underwent surgical angioplasty of coronary ostia with a patch of autologous pericardium. After angioplasty, TEE showed dilatation of left main coronary ostium and her clinical symptom improved.
Angioplasty ; Aortic Valve ; Aortitis ; Chest Pain ; Constriction, Pathologic* ; Coronary Vessels ; Diabetes Mellitus ; Dilatation ; Female ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II ; Hypertension ; Pericardium ; Smoke ; Smoking ; Syphilis ; Syphilis, Cardiovascular

Chronic granulomatous disease is characterized by recurrent life-threatening infections and the formation of granulomatous lesions caused by the failure of phagocytic oxidative microcidal activity that has resulted from a defect of the oxidase system. The fungal osteomyelitis of the spine in this disease is almost always caused by Aspergillus, and its treatment is not yet established although surgical management, antifungal agents, granulocyte transfusions or combination methods have been reported. We report a patient with aspergillosis who had a long-standing pulmonary lesion which subsequently spread to the adjacent thoracic wall and spine. After decompression and drainage by costotransversectomy, the severe pain was relieved but the kyphosis increased and a paraplegia developed slowly because of resistance to the antifungal therapy and the inability to perform a bone graft. The patient died 2 months after the operation because of pulmonary complications.
Antifungal Agents ; Aspergillosis* ; Aspergillus ; Decompression ; Drainage ; Glucose Oxidase ; Granulocytes ; Granulomatous Disease, Chronic* ; Humans ; Kyphosis ; Osteomyelitis ; Oxidoreductases ; Paraplegia ; Spine* ; Thoracic Wall ; Transplants

OBJECTIVES: To evaluate characteristics and results of treatment of scoliosis associated with Marfan syndrome METHODS: The clinical data of 57 patients diagnosed as Marfan syndrome from January 1989 to June 1999 were reviewed. Thirty one patients had major curves more than 10 degrees by Cobb's method on whole spine standing film and their curve patterns and treatment methods were analyzed. Twelve cases of Marfan scoliosis who underwent posterior instrumented fusion were compared with randomly-sampled cases with idiopathic scoliosis about flexibility, correctability and correction loss of curves. RESULTS: Scoliosis was identified in 31 of 57 patients (54.4%) and among them 15 patients had the curve more than 40 degrees. Twelve curves were double major, 10 were thoracic, and 8 were double thoracic. Seventy-five per cent of the 57 patients had congenital heart disease and 40% had lens dislocation. Twelve of 31 cases underwent posterior fusion with pedicle screw instrumentation. Marfan scoliosis (mean flexibility; 39% in thoracic, 52% in lumbar) were significantly less flexible than idiopathic scoliosis (60% in thoracic, 93% in lumbar) (P<0.05). Mean correctability of Marfan scolisis of operation (61% in thoracic, 55% in lumbar) was poorer than that of idiopathic scoliosis (72% in thoracic, 67% in lumbar), however, this was not significant statistically (P>0.05). Mean correction loss in Marfan syndrome was 3.2% at the mean 4.1 year follow-up in 9 cases. CONCLUSIONS: The prevalence of scoliosis in Marfan syndrome shows positive correlation with severity of the disease. As compared to idiopathic scoliosis, the curve associated with Marfan syndrome was larger and less flexible. After posterior fusion using pedicle screw instrumentation, the correctability of Marfan curve was poorer than that of idiopathic curve, which is, however, insignificant statistically. So it was considered to be a good method to treat Marfan scoliosis.
Follow-Up Studies ; Heart Defects, Congenital ; Humans ; Lens Subluxation ; Marfan Syndrome* ; Pliability ; Prevalence ; Scoliosis* ; Spine

PURPOSE: The purpose of the present study was to compare the osteoconduction in porous bodies made of various compositions of calcium phosphate compounds and other porous artificial bones. MATERIALS AND METHODS: Single-level posterolateral spinal fusions were performed on ninety rabbits. The animals were divided into nine groups by graft materials: autograft (positive control), implantation of HA, TCP, CPP, HA/TCP composite, TCP/CPP composite, Lubboc(R) and Calcium sulfate pellet (CSP), no-graft after decortication (negative control). Serial radiography, serum calcium and phosphorus levels were checked. All animals were sacrificed 12 weeks after surgery and the fusion masses were compared by manual palpation, uniaxial tensile strength measurement and histological evaluation. RESULTS: Autografted and CPP implanted groups showed significantly higher fusion ratio than TCP, TCP/CPP composite, and no-graft groups. Meanwhile, HA and HA/TCP groups showed no significant difference with other groups in fusion ratio. From the radiological examination, TCP and CPP groups seemed to show more rapid absorption of implant than HA group. The mean values of tensile strength of autografted and CPP group were significantly larger than those of TCP, TCP/CPP composite, and no-graft groups. The result of direct inspection and microscopic examination showed the TCP-contained implants lost their porous structure, whereas the other implants did not. On the light microscopy, both HA and CPP groups showed more abundant new bone growth into the pores than TCP-contained groups, but the pore size of CPP became larger than that of the HA, which manifested more rapid absorption of CPP in the living body. CONCLUSION: The porous CPP implant is considered to be more desirable bone graft substitute because it has satisfactory osteoconductive ablility and better biodegradation than porous HA. And the maintenance of porous structure is considered to be indispensable for osteoconduction.
Absorption ; Animals ; Autografts ; Bone Development ; Bone Regeneration ; Calcium Sulfate ; Calcium* ; Lumbar Vertebrae* ; Microscopy ; Palpation ; Phosphorus ; Rabbits ; Radiography ; Spinal Fusion ; Tensile Strength ; Transplants