No abstract available.
Drug Therapy* ; Methotrexate* ; Uterine Cervical Neoplasms*

No abstract available.
Chromosome Aberrations* ; Oncogenes*

PURPOSE: The purpose of this study is to analyze the position of the 10-mm-sized femur tunnel drilled aiming for the bifurcate ridge using anteromedial portal technique with 'Figure of 4 position' by 3-dimensional computed tomography (3D-CT) reconstruction images after anatomic anterior cruciate ligament (ACL) reconstruction and to evaluate it's propriety. MATERIALS AND METHODS: Out of 35 patients who underwent anatomic ACL reconstruction from March 2012 to February 2013, 32 patients who undergone postoperative 3D-CT scans were included in this study retrospectively. Medial surface of the lateral femoral condyle was reconstructed using Mimics, and then the position of the femoral tunnel was evaluated using the Bernard quadrant method and the results were compared with those of published literatures. The mean age of the patients was 32.6 years old. There were 25 cases of double-bundle ACL reconstruction with one femoral-two tibial tunnel. There were 7 cases of single bundle ACL reconstruction with one femoral-one tibial tunnel. RESULTS: The mean distance of the femoral tunnel center was 32.2%+/-2.9% (range, 27.4%-37.6%) along the line parallel to the Blumensaat's line from the posterior condylar surface and 46.7%+/-2.3% (range, 43.5%-51.1%) along the line perpendicular to the Blumensaat's line from the roof of the notch. In comparison with the results of published literature, although the center of the femoral tunnel was presented in the femoral footprint, it was located slightly more shallow and inferior than the center of the ACL footprints. CONCLUSION: The bifurcate ridge may be a good anatomic landmark when making a 10-mm-sized single femoral tunnel in 'Figure of 4 position' using the anteromedial portal technique.
Anatomic Landmarks ; Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction* ; Femur ; Humans ; Retrospective Studies

Rotor syndrome is a rare benign familial disorder characterized by chronic, fluctuating, nonhemolytic and predominantly conjugated hyperbilirubinemia with normal liver tissue. In contrast to Dubin-Johnson syndrome, there is no liver hyperpigmentation in Rotor syndrome, and BSP clearance does not show a secondary retention peak. The serum bilirubin in patients with Gilbert's syndrome is almost all unconjugated in contrast to Rotor syndrome. A 29-year-old male was admitted due to persistent jaundice. Physical examination revealed icteric sclera without hepatosplenomegaly. Laboratory findings showed increased serum bilirubin with indirect bilirubin predominance. Urinary excretion of total coproporphyrin was markedly elevated, and coproporphyrin I was 66% of total urinary coproporphyrin. Oral cholecystography showed well visualized the gallbladder, but 99mTc-DISIDA scan showed markedly decreased hepatic uptake and poor visualization of the gallbladder and biliary tract. Histology of the liver showed no abnormal finding. We report the case with the review of literature.
Adult ; Biliary Tract ; Bilirubin ; Cholecystography ; Gallbladder ; Gilbert Disease ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Hereditary* ; Hyperpigmentation ; Jaundice ; Jaundice, Chronic Idiopathic ; Liver ; Lymphoma ; Male ; Physical Examination ; Sclera ; Skin Neoplasms ; Survival Rate ; Technetium Tc 99m Disofenin

PURPOSE: Traditionally, external bleeding is needed when only an arteriorrhaphy can be performed in cased where a venorrhaphy cannot be done at the initial reconstruction for a zone I complete amputation. However, this salvage procedure has several iatrogenic complications. Therefore, we did not perform an external bleeding procedure, in cases where external bleeding was not appropriate due to the small size of the stump. METHODS: From September 2006 to August 2007, 19 fingertip amputations, among 18 patients, were performed using only arteriorrhaphy without external bleeding; In total 95 fingertip amputations, with venorrhaphy or external bleeding procedures were excluded. The results were reviewed retrospectively to compare survival and complication rates. RESULTS: The survival rate of only arteriorrhaphy without external bleeding is 84.2%. Additional operations for soft tissue problems of total or partial necrosis were performed in 5 cases. CONCLUSION: We found no differences in the survival and complication rates of only arteriorrhaphy without external bleeding compared to results of only arteriorrhaphy with external bleeding in other articles. Therefore, our results suggest that in some cases with a fingertip amputation, performing arteriorrhaphy only, without external bleeding, might be a better option than external bleeding due to reduced iatrogenic injuries and complications.
Amputation ; Hemorrhage ; Humans ; Necrosis ; Replantation ; Retrospective Studies ; Survival Rate

PURPOSE: Transverse type or volar oblique type of defect of thumb tip can be covered by Moberg flap or second toe pulp free flap. We compared these two methods in functional result, patients' satisfaction, and sensation, etc. to find a better way to cover the defect of the thumb tip. METHODS: From 2003 to 2006, we chose the patients randomly with preoperative pictures. The patients had the defect of the thumb tip which is either transverse or volar oblique type. The 6 patients were treated with Moberg flap and other 6 patients were treated with second toe pulp free flap. We have analyzed the results by 2 point discrimination, side pinching power test, pulp to pulp pinching power test, pain scales (visual analogue scale), satisfaction scales of the patients (functional and aesthetic), the degree of the range of motion, etc. RESULTS: All flaps survived without any complications. In the cases of Moberg flaps, the value of static 2 point discrimination test was 5.6mm, and the value of moving 2 point discrimination test was 4.8mm. In the cases of second toe pulp free flaps, the values were 9.6mm and 9.3mm. In the cases of Moberg flaps, the value of the Side pinch power test was 6.6kg, 4.4kg. In the case of second toe pulp free flaps, the values were 4.8kg and 2.5kg. The value of aesthetic satisfaction scale of the patients in Moberg flaps was 5.6, the value of functional satisfaction scale of the patients was 3.6. In cases of second toe pulp free flaps, the values were 5.6 and 3.6. The active range of motion of Interphalangeal joint in the cases of Moberg flaps was 46.6 degree, and the active range of motion of metacarpophalangeal joint was 55 degree, in the cases of second toe pulp free flaps, the values were 36.6 degree and 59 degree. CONCLUSION: As a result, when the defect of the thumb tip is transverse or volar oblique type, we suggest that the operators choose Moberg flap to cover the defect of the thumb tip.
Amputation ; Discrimination (Psychology) ; Free Tissue Flaps ; Humans ; Joints ; Metacarpophalangeal Joint ; Range of Motion, Articular ; Sensation ; Thumb ; Toes ; Weights and Measures

BACKGROUND: Nonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model. METHODS: Two-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies. RESULTS: Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates. CONCLUSIONS: Therefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.
Animals ; Blood Vessels ; Fibrosis ; Fingers ; Follow-Up Studies ; Foreign Bodies ; Formycins ; Granuloma ; Hand ; Humans ; Medical Records ; Polydioxanone ; Postoperative Complications ; Retrospective Studies ; Ribonucleotides ; Rupture ; Sutures ; Tendon Injuries ; Tendons

PURPOSE: First web space contracture of the hand has been treated with various surgical techniques such as Z-plasty, local flap, pedicled flap, distant free flap, and anterolateral thigh free flap. Among those surgical techniques, anterolateral thigh free flap provide a thin and pliable flap, which is a useful method for correction of first web space contracture. METHODS: From August 2003 to September 2007, the authors selected 9 patients who had first web space contracture with limitation of thumb abduction within 30 degrees. All of patients had received first web contracture release with anterolateral thigh free flap. Age ranged from 24 to 51, and all the patients were male. Average follow up period was 12 months and the authors performed photographic analysis of the thumb abduction angle of postoperative increase. RESULTS: All the flaps were survived. Donor site was closed with primary closure in 8 cases and covered with split-thickness skin graft in 1 case. Average flap size was 8x9cm and average thickness was 0.6cm in suprafascial flap. The procedure resulted in increased thumb abduction angle of 34.7degrees in average and showed concave shape of first web space in suprafascial flap. Additional operations were performed with Z-plasty in 3 cases, local flap in 5 cases, and opponensplasty in 3 cases. CONCLUSION: In suprafascial flap, we obtained relatively thin flap thickness and were able to make natural concave shape of first web space. In releasing severe contracture of the first web space, anterolateral thigh free flap provided a good coverage of appropriate thickness and pliable soft tissue and allowed limited donor site morbidity.
Contracture ; Follow-Up Studies ; Free Tissue Flaps ; Hand ; Humans ; Male ; Skin ; Surgical Flaps ; Thigh ; Thumb ; Tissue Donors ; Transplants

BACKGROUND: In this study, we characterize the morbidity at the donor-site of partial second toe pulp free flaps in terms of wound management as well as long-term outcomes. METHODS: A single-institutional retrospective review was performed for patients who had undergone partial second toe pulp free flap transfer to the fingertip. Patient charts were reviewed for infection, skin necrosis, wound dehiscence, and hematoma for the donor site. Additionally, a questionnaire survey was given to patients who had a follow-up of longer than 1 year to characterize long-term postoperative pain and appearance. RESULTS: The review identified a total of 246 cases. Early wound complications were significant for wound dehiscence (n=8) and hematoma (n=5) for a wound complication rate of 5.3%. The questionnaire was distributed to 109 patients, and 54 patients completed the survey. Out of these 54 patients, 15 patients continued to have donor-site pain (28%) at a mean follow-up period of 32.4 months. However, the pain intensity was relatively low in the range between 2 to 5, on a 0-10 scale. None of these patients felt this donor-site pain interfered significantly with daily activity, nor did any patient require pain medications of any type. Donor-site appearance was satisfactory to most patients. CONCLUSIONS: The partial second toe pulp flap was associated with low rates of wound complications and favorable long-term outcomes. Given the functional and aesthetic gain in the recipient finger, donor-site morbidities appear acceptable in this patient population. This study can be helpful in counseling patients regarding donor-site morbidity during the informed consent process.
Counseling ; Fingers ; Follow-Up Studies ; Free Tissue Flaps* ; Hematoma ; Humans ; Informed Consent ; Necrosis ; Pain, Postoperative ; Retrospective Studies ; Skin ; Tissue Donors ; Toes* ; Transplant Donor Site ; Wounds and Injuries

The accepted method in treating deep burns and severe crushing injuries of dorsum of the hand is serial debridement and delayed closure. Delayed wound closure with skin graft, local flap or regional pedicle flap may produce joint stiffness, tendon adhesion, and immobility. Emergency free flap transfer suggests against these concepts by advocating radical debridement and early closure of these wounds. Early mobilization of the joints with emergency free flap transfer may produce better range of motion than delayed closure. The key to success in early coverage of these wounds is thorough debridement while sparing vital structures, such as nerves, tendons, and intact vessels. We discussed 3 cases, which were performed emergency free flap transfer using lateral arm flap in severe crushing injuries and deep burns of dorsum of the hand. All flaps survived without complications. Each joints had shown 95% range of motion of contralateral normal side on the average. Emergency free flap transfer allows early closure of acute soft tissue defect of dorsum of the hand, promoting early motion and possibly reducing the incidence of post-operative infection, flap failure and secondary operative procedures, and improving functional results.
Arm ; Burns* ; Debridement ; Early Ambulation ; Emergencies* ; Free Tissue Flaps* ; Hand* ; Incidence ; Joints ; Range of Motion, Articular ; Skin ; Surgical Procedures, Operative ; Tendons ; Transplants ; Wounds and Injuries