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

Intraabdominal abscess, resulting from primary intraperitoneal disease such as appendicitis, diverticulitis or as a complication of surgery, remains a serious problem with high mortality if not treated early and adequately. In the case of acute bowel perforation, surgery is the treatment of choice, but radiologically guided percutaneous drainage is very effective for the subacute and localized abscess within the peritoneal cavity. However, perirectal abscesses located deep within the pelvis are unapproachable percutaneously because of interposed structures such as the urinary bladder, loops of bowel. Transrectal drainage overcomes these limitations. We present here a case of perirectal abscess treated successfully and safe with transrectal catheter drainge.
Abdominal Abscess ; Abscess* ; Appendicitis ; Catheterization ; Catheters* ; Diverticulitis ; Drainage* ; Mortality ; Pelvis ; Peritoneal Cavity ; Urinary Bladder

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

PURPOSE: We report the results of A2 pulley reconstruction following revascularization for crushing or amputation injury of the hand. MATERIALS AND METHODS: The A2 pulley reconstruction was performed in 5 patients(5 digits) in whom the flexion of finger is restricted due to loss of the A2 pulley. All the patients underwent replantation or revascularization for the treatment of crushing or amputation injury of hand. Methods for reconstructing pulley were a tendon graft using palmaris longus(3 cases) and extensor retinaculum(2 cases). For assessments, the total active range of motion was measured. RESULTS: Total active range of motion increased by a mean of 39degrees(range, 15~100degrees) after pulley reconstruction. The mean improvement was 44%(range, 12~69%) of the maximum expected motion. CONCLUSION: In patients who underwent replantation or revascularization, the A2 pulley reconstruction after multiple-stage of flexor tendon reconstruction is a way to improve the active range of motion when the finger flexes.
Amputation ; Fingers ; Hand ; Humans ; Range of Motion, Articular ; Replantation ; Tendons ; Transplants

The presence of a fingernail is important in facilitating tactile sensibility to finger pulp, stabilizing the tip for refined pinch, scratching and providing dorsal protection. Many reconstructive procedures have been introduced in the past for reconstruction of the nail. The authors performed a reconstruction of the nail in 13 patients using a split-thickness nail bed graft. Results of nail growth in reconstructed nail were judged as good, fair, or poor on the basis of appearance of nail and the patient's satisfaction. The outcome of the 13 cases (mean follow-up of 11 months) was good in eight cases, fair in three cases, and poor in two cases, respectively. Although the authors' experience suggests the unpredictable nature of nail bed graft, it should be considered for patients who desire nail reconstruction and are not candidates for ablation or vascularized nail complex transfer procedure.
Fingers ; Follow-Up Studies ; Humans ; Nails ; Transplants*

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

PURPOSE: In the case of repair for far distal parts of FDP (Flexor digitorum profundus) division, the method of either pull-out suture or fixation of tendon to the distal phalanx is preferred. In this paper, the results of a modified loop suture technique used for the complete division of FDP from both zone 1a and distal parts of zone 1b in Moiemen classification are presented. METHODS: From July 2006 to July 2009, the modified loop suture technique was used for the 10 cases of FDP in complete division from zone 1a and distal parts of zone 1b, especially where insertion sites were less than 1 cm apart from a tendon of a stump. In a suture technique, a loop is applied to each distal and proximal parts of tendon respectively. Core suture of 2-strand and epitendinous suture are done with PDS 4-0. Out of 10 patients, the study was done on 6 patients who were available for the follow-up. The average age of the patients was 49.1 years (in the range from 26 to 67). 5 males and 1 female patients were involved in this study. There were 3 cases with zone 1a and distal parts of zone 1b. The average distance to the distal tendon end was 0.6 cm. There were 5 cases underwent microsurgical repair where both artery and nerve divided. One case of only tendon displacement was presented. The dorsal protective splint was kept for 5 weeks on average. The results of the following tests were measured: active & passive range of motion, grip strength test, key pinch and pulp pinch test. RESULTS: The follow-up period on average was 11 months, in the range from 2 to 20 months. There was no case of re-rupture, but tenolysis was performed in 1 cases. In all 6 cases, the average active range of motion of distal interphalangeal joint was 50.8 degree. The grip strength (ipsilateral/contralateral) was measured as 88.7% and the pulp pinch test was 79.2% as those of contralateral side. Flexion contracture was presented in 2 cases (15 degree on average) and there was no quadrigia effect found. CONCLUSION: Despite short length of tendon from the insertion site in FDS rupture in zone 1a and distal parts of zone 1b, sufficient functional recovery could be expected with the tendon to tendon repair using the modified loop suture technique.
Arteries ; Contracture ; Displacement (Psychology) ; Female ; Follow-Up Studies ; Formycins ; Hand Strength ; Humans ; Joints ; Male ; Range of Motion, Articular ; Ribonucleotides ; Rupture ; Splints ; Suture Techniques ; Sutures ; Tendons