The management of chronic skin defect over the pretibial region, sacral pressure sore and other bony protuberant area is extremely difficult due to the presence of necrotic and infected bone, avascular and infected scar tissue, dead space and anatomical sparse of available adjacent structure. The present methods of management include versatile varieties and have left much to be revised, but they often despaired of both surgeon and patient, especially due to persistent chronic osteomyelitis and recurrent ulcer. From January, 1975 to April, 1979, we have had treated 20 such cases with application of muscle flap transposition and following has been observed. 1. The cause of lesion were 11 cases of the traffic accident, 4 cases of the industrial accident, 2 cases of the falling from a height, 2 cases of the pressure sore and 1 case of the chronic osteomyelitis. And 15 cases of them were physically active young adult between 2nd decade to 4th decade. 2. The muscles used for pretibial lesion were medial head of gastrocnemius m., soieus m., flexor digitorum longus m. and peroneus brevis m. Used abductor hallucis m. for medial malleolar defect, gluteus maximus m. for sacral pressure sores and sartorius m. for exposed knee joint. 3. There existed hematoma formation in 2 cases, partial necrosis of transposed muscle in 3 cases and persistent infected sinuses in 3 cases. Other cases except the last 3 cases, which needed another surgical procedure and antibiotic therapy, were controlled without difficulty and all of them did not develope any recurrence of ulcer during the follow up duration. 4. There did not appear to be any significant long term functional residua due to loss of original function of the transposed muscle except somewhat unacceptable cosmetic result. 5. It was 2 months average for the healing cases which did not need a bone graft and 5 months average for the cases needed a bone graft.
Accidental Falls ; Accidents, Occupational ; Accidents, Traffic ; Cicatrix ; Follow-Up Studies ; Head ; Hematoma ; Humans ; Knee Joint ; Muscles ; Necrosis ; Osteomyelitis ; Pressure Ulcer ; Recurrence ; Sacrococcygeal Region ; Skin ; Transplants ; Ulcer ; Young Adult

No abstract available.
Genetic Therapy* ; Oligonucleotides*

A recurrent shoulder joint dislocation was performed on fourteen cases who were treated by modified Bristow operation from June, 1978 to April, 1981. and following results were obtained. 1. The age of initial dislocation varied from 13 years to 23 years of age with the average of 18. 6 years. 2. The age at operation varied from 20 years to 28 years of age with the average of 23 years. 3. The duration of recurrent dislocaticn varied from 2 years to 8 years with the average of 4.4 years. 4. The times of dislocation varied from 6 to 50 times with the average of 17.1 times. 5. The roentgenograms showed the Hill-Sachs' Iesion in 10cases (71.4%), subluxation in 4 cases (28.6%), and glenoid rim abnormality in 2 cases. 6. The operative findings were Bankart's lesion in II cases(78.6%), glenoid rim erosion in 2 case, and subscapularis laxity in 2 case. 7. The complication and recurrence were not observed in this period. 8. The average limitation of abduction and external rotation were 5. 7 and 12. 2 degree respectively.
Dislocations ; Recurrence ; Shoulder Dislocation ; Shoulder Joint ; Shoulder

This research explored the synergistic effects and the potential mechanisms of RCE-4 and various nonsteroidal anti-inflammatory drugs (NSAIDs) on the proliferation of cervical cancer Ca Ski cells. The MTT assay and CalcuSyn V2.0 software were used to detect cell proliferation and calculate the combination index (CI); the expression levels of various proteins were analyzed using Western blot assay; mitochondrial membrane potential (MMP) was assessed using JC-1 staining; acridine orange/ethidium bromide (AO/EB) double-fluorescence staining was used to detect the apoptosis of Ca Ski cells; a co-immunoprecipitation (Co-IP) assay was used to analyze the relative content of Bcl-2-Beclin 1 complex in Ca Ski cells. The results demonstrate that the combination of RCE-4 and NSAIDs increases the inhibition of Ca Ski cells compared to the single-RCE-4 group, and celecoxib provided the best synergistic effect among the four NSAIDs tested, with a CI of 0.32. The combination of RCE-4 and celecoxib significantly down-regulated the expression of cyclooxygenase-2 (COX-2) and nuclear transcription factor-κB (NF-κB), and promoted the expression of non-steroidal anti-inflammatory drugs activity gene-1 (NAG-1). In addition, autophagy induced by RCE-4 was markedly inhibited in combination with celecoxib, which was associated with down-regulation of the expression of microtubule-associated protein 3 (LC3)-II, Beclin 1, p62 and autophagy-related gene (ATG) 3/4B/5/7/14. RCE-4-induced apoptosis was significantly enhanced by altering the depolarization of mitochondrial membrane potential and the expression of B cell lymphoma-2 (Bcl-2), B cell lymphoma-xl (Bcl-xl), Bcl-2 associated X protein (Bax), Bcl-2/Bcl-xl-associated death promoter (Bad) and cleaved cysteinyl aspartate specific proteinase (cleaved-caspase) 3/7/9. Furthermore, the formation of the Bcl-2-Beclin 1 complex was significantly inhibited in Ca Ski cells treated with RCE-4 in combination with celecoxib. Taken together, this research shows that the combination of RCE-4 and celecoxib has a significant synergistic effect on the proliferation of Ca Ski cells by promoting apoptosis, inhibiting autophagy and disturbing the formation of the Bcl-2-Beclin 1 complex, which may be a novel strategy to increase the sensitivity of anti-cervical cancer drugs.

We studied 249 patients with risk factors of retinopathy of prematurity and the results were as follows: 1. Among 249 patients, retinopathy of prematurity(ROP) developed in 36 patients(14.5%). 19 patients(528%) were stage 1, 4(11.1%) patients were stage 2, 11 patients(30.6%) were stage 3, 2 patients(56%) were stage 4 and there was no stage 5 ROP patient. 2. In gestational age, there was not statistically significant difference between normal lnfants and under-prethreshold stage group, but there were statistically significant differences between normal or under-pretheshold stage group and pretheshold or theshold stage group and was not stastically significant difference between prethreshold stage and threshold stage. 3. In birth weight, there was statistically significant difference between normal group and under-prethreshold stage group and also be statistically significant differences between normal or under-prethreshold stage and pretheshold or threshold stage group but there was not statistically significant difference between prethreshold stage and threshold stge. 4. In duration of oxygen therapy, there were no statistically Significant differences among each group.
Birth Weight ; Gestational Age ; Humans ; Oxygen ; Retinopathy of Prematurity* ; Risk Factors

PURPOSE: Hypovolemia is not uncommon among trauma patients in the emergency department (ED). Successful resuscitation of a hypovolemic patient often requires rapid intravenous administration of massive amounts of fluid. A rapid fluid infuser is used in the ED for this purpose, there have been no studies of their clinical uses and effectiveness. We studied clinical experience with a rapid fluid infuser at an urban university hospital in Seoul, Korea. METHODS: We reviewed the medical records of 38 patients admitted to the ED with a history of application of a rapid fluid infuser from January 2004 to July 2005. Adult trauma patients older than 15 years of age were included in this study. Clinical data on the patients and the volume of fluid used to achieve a stable blood pressure were extracted from their medical records. RESULTS: The total number of adult trauma patients with a history of application of a rapid fluid infuser from January 2004 to July 2005 in the ED was 16. The mean systolic blood pressure for deciding to apply the rapid fluid infuser was 74.9+/-12.7 mmHg. The mean time and volume used to achieve a stable blood pressure were 40.4 min and 2947.3+/-1339.2 ml, respectively. In all patients, the amount of fluid infused before using the rapid fluid infuser was between 500 ml and 10,000 ml, compared to 1,000 ml and 6,200 ml with the rapid fluid infuser. The mean amount of fluid per min. via the rapid fluid infuser was 85.5 ml. Vital signs were stabilized in 11 patients, 6 of the 11 were discharged alive. CONCLUSION: The mean amount of fluid delivered per min. via the rapid fluid infuser was much less than expected; thus, there should be clinical guidelines on volume resuscitation with a rapid fluid infuser in the ED. In the future, prospective, multicenter, clinical-data collection is needed for a more sophisticated study.
Administration, Intravenous ; Adult ; Blood Pressure ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypovolemia ; Infusion Pumps ; Korea ; Medical Records ; Resuscitation ; Seoul ; Shock ; Vital Signs

Behcet syndrom is a chronic systemic disease developing recurrent oral and genital ulceration, ocular inflammation, arthritis and neurological manifestations. Anterior uveitis and occlusive retinal vasculitis are the most commom ocular manifestation of Behcet syndrome. A 29 years old Korean male with abducens palsy (6th cranial nerve palsy) was found to have oral aphthae, genital ulcer, skin lesion and other neurological manifestations (weakness and sensory loss of lower extremeties, ataxic gait, speech disturbance and urinary difficulty), but he had neither ocular manifestation such as uveitis nor retinal vasculitis.
Adult ; Arthritis ; Behcet Syndrome ; Cranial Nerves ; Gait ; Humans ; Inflammation ; Male ; Neurologic Manifestations ; Paralysis* ; Retinal Vasculitis ; Skin Ulcer ; Stomatitis, Aphthous ; Ulcer ; Uveitis ; Uveitis, Anterior

PURPOSE: Crowding causes dysfunction in the emergency department (ED) and is associated with poor quality of patient care, dissatisfaction of the physicians, and increased financial burden of medical care. Frequent use is often considered a major contributor to ED crowding. The present study sought to verify the relationship between the frequent ED users and ED crowding, and to ascertain the severity of the frequent ED users. METHODS: One-year ED visit data from a tertiary teaching hospital located in an urban area were analyzed. Frequent ED users were defined as four or more ED visits per year. Crowding indicators were defined as the length of stay and the percentage of patients staying over 6 hours. Severity indicators were defined as operation within 24 h, admission to intensive care unit, and expiry in the ED. RESULTS: The 2.7% of patients who had four or more ED visits were responsible for 11.9% of visits. The median length of stay of frequent users was significantly longer (6.18 h) than that of infrequent users (3.42 h). The percentage of patients who stayed more than 6 h was significantly larger in the frequent user group than infrequent user group (51.4% vs. 32.9%, respectively; OR=2.158; 95% CI, 2.041~2.281). However, the severity of frequent users was lower than that of infrequent users (3.0% vs. 5.3%, respectively; OR=0.553; 95% CI, 0.472~0.648). CONCLUSION: Frequent users presenting to an ED located in an urban area were more likely to stay longer in the ED, and were less likely to be severe. Active interventions to reduce ED crowding are required.
Crowding ; Emergencies ; Emergency Medical Services ; Health Services Misuse ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Length of Stay ; Patient Care

PURPOSE: Crowding causes dysfunction in the emergency department (ED) and is associated with poor quality of patient care, dissatisfaction of the physicians, and increased financial burden of medical care. Frequent use is often considered a major contributor to ED crowding. The present study sought to verify the relationship between the frequent ED users and ED crowding, and to ascertain the severity of the frequent ED users. METHODS: One-year ED visit data from a tertiary teaching hospital located in an urban area were analyzed. Frequent ED users were defined as four or more ED visits per year. Crowding indicators were defined as the length of stay and the percentage of patients staying over 6 hours. Severity indicators were defined as operation within 24 h, admission to intensive care unit, and expiry in the ED. RESULTS: The 2.7% of patients who had four or more ED visits were responsible for 11.9% of visits. The median length of stay of frequent users was significantly longer (6.18 h) than that of infrequent users (3.42 h). The percentage of patients who stayed more than 6 h was significantly larger in the frequent user group than infrequent user group (51.4% vs. 32.9%, respectively; OR=2.158; 95% CI, 2.041~2.281). However, the severity of frequent users was lower than that of infrequent users (3.0% vs. 5.3%, respectively; OR=0.553; 95% CI, 0.472~0.648). CONCLUSION: Frequent users presenting to an ED located in an urban area were more likely to stay longer in the ED, and were less likely to be severe. Active interventions to reduce ED crowding are required.
Crowding ; Emergencies ; Emergency Medical Services ; Health Services Misuse ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Length of Stay ; Patient Care

The authors have recently experienced a case of conjunctival papilloma which was developed on whole conjunctiva. The 6-year-old girl has soft, pinkish and pedunculated culated growth with delicate finger like processes in the right eye. The processes are scattered all over the mucous membrane of the bulbar and palpebral conjunctiva in considerable numbers. It is probable that many of these pedunculated types are of viral origin and that their spreads are due to contact infection. The papilloma of viral origin has no evidence of distant metastasis or malignant changes. The treatment was performed by electric cauterization with hyfricator and the result has been excellent up to date, 6 months after cauterization.
Cautery ; Child ; Conjunctiva ; Female ; Fingers ; Humans ; Mucous Membrane ; Neoplasm Metastasis ; Papilloma*