OBJECTIVE: The purpose of this study was to analyze the relationship between fracture pattern and the development of acute radiculopathy after osteoporotic lumbar compression fracture. METHODS: This study included 59 patients who underwent bone cement augmentation for osteoporotic compression fracture below the L2 level, which can lead to radiculopathic radiating pain. The patients were divided into two groups according to the presence of radiculopathy (group A : back pain only; group B : back pain with newly developed radiating pain). We categorized compression fractures into three types by the position of the fracture line. The incidence of newly developed radiculopathy was examined retrospectively for each compression fracture type. RESULTS: The overall incidence of newly developed leg pain (group B) was 25%, and the frequency increased with descending spinal levels (L2 : 0%, L3 : 22%, L4 : 43%, and L5 : 63%). The back pain-only group (group A) had mostly superior-type fractures. On the other hand, the back pain with radiculopathy group (group B) had mostly inferior-type fractures. Most patients in group B showed significant relief of leg pain as well as back pain after bone cement augmentation. CONCLUSION: The incidence of a newly developed, radiating pain after osteoporotic compression fractures increased gradually from the L3 to L5 levels. Most of these fractures were of the inferior type, and the bone cement augmentation procedures seemed to be sufficient for relief of both back and radiating pain.
Back Pain ; Fractures, Compression* ; Hand ; Humans ; Incidence ; Leg ; Osteoporosis ; Radiculopathy* ; Retrospective Studies

PURPOSE: The purpose of this study was to investigate the possibility that a dynamic facial composite flap with sensory and motor nerves could be made available from donor facial composite tissue. METHODS: The faces of 3 human cadavers were dissected. The authors studied the donor faces to assess which facial composite model would be most practicable. A "panorama facial flap" was excised from each facial skeleton with circumferential incision of the oral mucosa, lower conjunctiva and endonasal mucosa. In addition, the authors measured the available length of the arterial and venous pedicles, and the sensory nerves. In the recipient, the authors evaluated the time required to anastomose the vessels and nerve coaptations, anchor stitches for donor flaps, and skin stitches for closure. RESULTS: In the panorama facial flap, the available anastomosing vessels were the facial artery and vein. The sensory nerves that required anastomoses were the infraorbital nerve and inferior alveolar nerve. The motor nerve requiring anstomoses was the facial nerve. The vascular pedicle of the panorama facial flap is the facial artery and vein. The longest length was 78mm and 48mm respectively. Sensation of the donor facial composite is supplied by the infraorbital nerve and inferior alveolar nerve. Motion of the facial composite is supplied by the facial nerve. Some branches of the facial nerve can be anastomosed, if necessary. CONCLUSION: The most practical facial composite flap would be a mid and lower face flap, and we proposed a panorama facial flap that is designed to incorporate the mid and lower facial skin with and the unique tissue of the lip. The panorama facial composite flap could be considered as one of the practicable basic models for facial allotransplantation.
Arteries ; Cadaver ; Conjunctiva ; Facial Nerve ; Facial Transplantation ; Humans ; Lip ; Mandibular Nerve ; Mouth Mucosa ; Mucous Membrane ; Sensation ; Skeleton ; Skin ; Tissue Donors ; Veins

We studied the results of the immediate microsurgical reconstruction of the distal digit injury with short vascular pedicled partial toe transfer. Thirteen patients with amputation or crush injury of the distal digit who underwent partial toe transfer at the authors' institute over 8-year period were reviewed. Delay between initial injury and reconstruction ranged from 1 to 9 days. All flaps were harvested on a short vascular pedicle, with anastomoses performed at a proximal interphalangeal joint level on the fingers and metacarpophalangeal joint level on the thumbs. Good to excellent cosmetic and functional results were obtained in all cases, with nearly normal-looking fingertip. The mean static two point discrimination was 10 mm. Immediate reconstruction with short vascular pedicled partial toe transfer is an excellent option for the reconstruction of the compostie defect of the distal digit.
Amputation ; Cosmetics ; Discrimination (Psychology) ; Fingers ; Humans ; Joints ; Metacarpophalangeal Joint ; Toes

PURPOSE: We tried to find the patients characteristics of parasternal recunence, to classify the parasternal recunence according to the radiological and clinical features, and to evaluate the efficacy of local radiotherapy. MATERIALS AND METHODS: Between August 1987 and April 1997, twenty one patients with parastemal recurrence of breast cancer after surgery with or without adjuvant chemotherapy were treated with radiotherapy. Age distribution at initial operation was ranged from 31 to 79 years(median 48 years). Sixteen(76.2%) cancers were in the right breast and five(23.8%) were in the left. The pathologic types were infiltrative ductal carcinoma in 18 patients and medullary carcinoma in 3 patients. Eight patients had stage I, three had stage IIa, six had stage IIb, one had stage IIIa diseases and we had no information about the initial stage of the other 3 patients. Parasternal recurrence were diagnosed by biopsy in 7 patients, and the other 14 recurrences were diagnosed by clinical and radiologic findings such as chest CT, whole body bone scan. All the patients were treated with radiation for the parasternal recurrent tumors. In addition, five patients also received chemotherapy(FAC or Taxol based protocol) and one patient also received partial resection before radiotherapy. Radiotherapy was delivered with Co-60 gamma-ray or 4~6 MV X-ray or electron beam to both supraclavicular lymph nodes and parasternal areas with total doses of 3000~6480 cGy(median 6100 cGy). RESULTS: The range of interval between curative resection and parasternal recurrence were 4~110 months(median 34 months). The main symptoms of the parasternal recurrence were a painless mass(n=10). The duration of symptom before diagnosis ranged from one to 36 months(median 7 months). Among 21, five patients(23.8%) presented distant metastses at the diagnosis of parasternal recurrences. The parasternal recurrences were classified into three groups according to radiologic and clinical findings; the recurrent tumors originated from sternum and invaded into adjacent tissues(Group 1, n=5), tumors originated from intemal mammary lymph nodes and invaded into sternum or parasternal tissues(Group 2, n=6), tumors originated from medial chest wall and invaded into sternum or parasternal tissues(Group 3, n=10). In nineteen patients(19/21; 90.5%) there was complete response of parasternal recurrence following radiotherapy. Although the follow up period was relatively short(3~78 montbs, median 14 months), there were no local recurrence in radiation field in 19 patients with complete response. Among the 16 patients without distant metastases at diagnosis of parasternal recurrence, nine patients were alive without any evidence of disease. CONCLUSION: Chest CT scan is necessary and effective in patients with parastemal discomfort, pain, swelling or palpable mass after mastectomy. And we found that radiotherapy was very effective for the local treatment of parasternal recunence in terms of symptom palliation and local control of tumor. Although we classified the parasternal recurrence into three groups, we could not reach any conclusive results because of short follow up duration and insufficient patients number.
Age Distribution ; Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Medullary ; Chemotherapy, Adjuvant ; Diagnosis ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mastectomy ; Neoplasm Metastasis ; Paclitaxel ; Radiotherapy ; Recurrence* ; Sternum ; Thoracic Wall ; Tomography, X-Ray Computed

This study was conducted to examine lymphocyte subset counts and mood states in panic disorder patients. Twenty patients with panic disorder and 20 age- and gendermatched normal healthy subjects were recruited for the study. We used the Spielberger State (STAIS) & Trait (STAIT) Anxiety Inventory, Hamilton Depression Rating scale (HAMD) and Hamilton Anxiety Rating scale (HAMA) to measure mood states in all subjects. Lymphocyte subsets counts were made by flow cytometry. Panic patients showed significantly higher scores for anxiety and depression than normal subjects. Panic patients showed no differences in terms of the numbers of immune cells, as compared with normal healthy subjects, other than a lower proportion of T suppressor cells and a higher T helper cell/T suppressor cell ratio. HAMA and STAIS scores were common factors that could predict T cell numbers and proportions, T helper cell numbers, and natural killer cell proportions in panic disorder patients. We suggest that anxiety levels are related to the T-cell population in panic disorder patients and that quantitative immune differences may reflect altered immunity in this disorder.
Adult ; *Affect ; Female ; Humans ; Lymphocyte Subsets/*immunology ; Male ; Panic Disorder/*immunology/psychology ; Regression Analysis ; Research Support, Non-U.S. Gov't

Routine preoperative tests such as BT/CT, PT/PTT and CBC, could not test abnormal hemostasis that take drugs and health functional food. We used platelet function analyzer (PFA(R))-100, to evaluate preoperative bleeding tendencies. From November 2008 to February 2010, 306 surgical patients were tested preoperative PFA in our hospital. There are 2 tests in PFA(R)-100. The Pre Operative EPI (collagen/epinephrine) assay tests extrinsic platelet function, whereas the Pre Operative ADP (collagen/adenosine diphosphate) assay tests intrinsic platelet function. We divided normal and abnormal groups by the PFA(R)-100 assay tests. If either of results were abnormal in the two tests, the patient was divided to the abnormal group. 306 surgical patients were observed with hemorrhagic complications. All of the patients were divided normal and abnormal groups by the PFA(R)-100 test result. The normal group was made up of 286 (93.5%) patients, the abnormal group was made up of 20 (6.5%) patients. We observed each group hemorrhage complication including sever echymosis and hematoma, and analyzed each group complication rate. There were 9 (3.1%) cases of complication in the normal group. There were 3 (15.0%) cases of complication in the abnormal group. To evaluate preoperative bleeding tendency, PFA(R)-100 can be complementary examination with previous routine blood coagulation tests.
Adenosine Diphosphate ; Blood Coagulation Tests ; Blood Platelets ; Functional Food ; Hematoma ; Hemorrhage ; Hemostasis ; Herbal Medicine ; Humans ; Platelet Function Tests ; von Willebrand Diseases

Blepharoptosis patients use frontalis muscle unconsciously to widen eye, and it results in several aesthetic problems-such as forehead wrinkling and elevated eyebrow. So forehead wrinkling and elevated eyebrow can be resolved with correction of blepharoptosis. We evaluated the change of eyebrow height in 30 patients who were corrected blepharoptosis through photogrammetry. The mean age of the patients was 36.8 years old and the mean follow up periods were 6 months. Horizontal line passing medial and lateral canthal corner in both eyes was drawn in Photopshop. From the horizontal line, 3 vertical lines perpendicular to this line were drawn passing medial and lateral canthal corner and the vertically oriented center of the pupil. Eyebrow height was measured through these 3 vertical lines. The average length of decreased value of the eyebrow height were 3.64 mm in H1, 3.31 mm in H2, 2.79 mm in H3. In unilateral cases, 2.42 mm in H1, 2.86 mm in H2, 2.78 mm in H3, and in bilateral cases, the decreased values were 4.25 mm in H1, 3.53 mm in H2, 2.79 mm in H3. From this study, the author would like to introduce the method to calculate the changes of eyebrow height after blepharoptosis correction and the values objectively.
Blepharoptosis ; Eye ; Eyebrows ; Follow-Up Studies ; Forehead ; Humans ; Muscles ; Photogrammetry ; Pupil

Salmonella-triggered reactive arthritis appears one to three weeks after the onset of salmonella infection and presents with asymmetric, usually migratory, oligo- or polyarthritis. The course is usually self-limiting and symptoms last two to six months. We experienced a 10-year-old male patient who presented to a local pediatric center with long-lasting fever and right ankle joint pain. The pain migrated to the left ankle joint, both wrists, and both knees and he was diagnosed as juvenile rheumatoid arthritis and was medicated with NSAIDs and corticosteroid. In the meantime, 20 days prior to the transfer to our hospital he was febrile with nausea and abdominal pain and the antibody titer of S. typhi O Ag by Widal test was 1 : 320, and an antibiotic therapy was followed. Soon after, the fever subsided but the migrating joint symptoms continued and he was transferred to our hospital. Widal tests were weekly checked and the antibody titers of S. typhi O Ag were 1 : 160, 1 : 320, 1 : 320, 1 : 160, 1 : 160, respectively. ESR was 55 mm/hr, CRP 9.18 mg/dl, HLA-B27 positive and his endoscopic findings of the colon showed mild lymphoid hyperplasia and mucosal nodularities in the cecum and ileocecal area. Stool cultures and duodenal juice culture for Salmonella and Shigella were all negative. He was treated with ibuprofen and bactrim and the joint symptoms were gradually mitigated. After discharge, he maintained mildly elevated CRP levels and antibody levels by Widal tests, but was free from symptoms except for several episodes of finger pains for 11 months.
Abdominal Pain ; Ankle Joint ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Arthritis, Juvenile* ; Arthritis, Reactive* ; Cecum ; Child* ; Colon ; Fever ; Fingers ; HLA-B27 Antigen ; Humans ; Hyperplasia ; Ibuprofen ; Joints ; Knee ; Male ; Nausea ; Salmonella ; Salmonella Infections ; Shigella ; Trimethoprim, Sulfamethoxazole Drug Combination ; Wrist

The effects of acidic pH on several voltage-dependent ion channels, such as voltage-dependent K⁺ and Ca²⁺ channels, and hyperpolarization-gated and cyclic nucleotide-activated cation (HCN) channels, were examined using a whole-cell patch clamp technique on mechanically isolated rat mesencephalic trigeminal nucleus neurons. The application of a pH 6.5 solution had no effect on the peak amplitude of voltage-dependent K⁺ currents. A pH 6.0 solution slightly, but significantly inhibited the peak amplitude of voltage-dependent K⁺ currents. The pH 6.0 also shifted both the current-voltage and conductance-voltage relationships to the depolarization range. The application of a pH 6.5 solution scarcely affected the peak amplitude of membrane currents mediated by HCN channels, which were profoundly inhibited by the general HCN channel blocker Cs⁺ (1 mM). However, the pH 6.0 solution slightly, but significantly inhibited the peak amplitude of HCN-mediated currents. Although the pH 6.0 solution showed complex modulation of the current-voltage and conductance-voltage relationships, the midpoint voltages for the activation of HCN channels were not changed by acidic pH. On the other hand, voltage-dependent Ca²⁺ channels were significantly inhibited by an acidic pH. The application of an acidic pH solution significantly shifted the current-voltage and conductance-voltage relationships to the depolarization range. The modulation of several voltage-dependent ion channels by an acidic pH might affect the excitability of mesencephalic trigeminal nucleus neurons, and thus physiological functions mediated by the mesencephalic trigeminal nucleus could be affected in acidic pH conditions.
Acidosis ; Animals ; Hand ; Hydrogen-Ion Concentration* ; Ion Channels* ; Membranes ; Neurons* ; Proprioception ; Rats* ; Tegmentum Mesencephali

OBJECTIVE: To evaluate the effectiveness of nonsurgical treatment and to evaluate the usefulness of ultrasonographic assessment in postburn hypertrophic scar. METHODS: The subjects were twenty-seven burn patients with hypertrophic scar. Hypertrophic scars were treated by four different methods: triamcinolone acetonide injection (Group I), pressure garment application (Group II), combination treatment of triamcinolone acetonide and garment (Group III) and no treatment (Group IV). To assess the effectiveness of each treatment method, ultrasonographic measurement of scar thickness and punch biopsy of scar were done before and after treatment. RESULTS: After 4 weeks treatment, the scar thickness decreased by 14.9 9.4% in Group I, 4.7 8.4% in Group II and 20.5 13.2% in Group III. However the scar thickness increased by 10.0 13.5% in Group IV (no treatment). The pathologic findings didn't show significant change. CONCLUSION: The TA solution injection therapy and pressure garment therapy were effective methods for the treatment of the postburn hypertrophic scar, but the combinations of both therapies was more effective than each single therapy. The ultrasonography can be used as objective measure to assess effectiveness of therapy.
Biopsy ; Burns ; Cicatrix ; Cicatrix, Hypertrophic* ; Humans ; Triamcinolone Acetonide ; Ultrasonography