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

Cilostazol is a phosphodiesterase inhibitor that has been shown to have similar efficacy in stroke prevention but fewer hemorrhagic events compared with aspirin. We report a case of spontaneous spinal epidural hematoma (SSEH) in a 67-year-old woman who has been treated with cilostazol for cerebral infarction. The patient was presented with sudden neck pain and right hemiparesis. Thirteen days after the onset, she recovered completely. Even cilostazol, which is a relatively safer drug in terms of bleeding risk compared to other antiplatelet agents, may cause SSEH. Therefore, physicians should keep in mind rare, but potentially fatal, bleeding complications such as SSEH when prescribing antiplatelet agents.
Aspirin ; Cerebral Infarction ; Female ; Hematoma, Epidural, Spinal ; Hemorrhage ; Humans ; Neck Pain ; Paresis ; Platelet Aggregation Inhibitors ; Stroke ; Tetrazoles

PURPOSE: A modified free thenar flap was designed for coverage of volar finger defect with constant innervation using the palmar cutaneous branch of the median nerve. After clinical application of this flap, sensory results were evaluated in 6 cases. METHODS: Patients were selected who have volar soft tissue defect with or without fingertip defect. The six cases of the innervated free thenar flap were performed since September 2009, and sensory outcomes were evaluated by the Semmes-Weinstein monofilament and two-point discriminator at four and half month after the surgery. RESULTS: The Semmes-Weinstein Monofilament test revealed 3 cases showed 2.83, 1 case showed 3.61, 1 case showed 4.31 and 1 case showed 4.56. The static two-point discrimination test revealed 1 case showed 4mm, 1 case showed 6mm, 2 cases showed 9mm, and 2 cases showed over 15mm. The moving two-point discrimination test revealed 1 case showed 3mm, 1 case showed 4mm, 1 case showed 5mm, 1 case showed 7mm, and 2 cases showed over 15mm. The donor sites showed no significant limitation of the thumb and neuroma formation. CONCLUSION: The innervated free thenar flap showed good sensory outcomes as a sensate free flap in a short time after surgery. It can be an option for coverage of volar finger defects that requires sensation.
Discrimination (Psychology) ; Fingers ; Free Tissue Flaps ; Humans ; Median Nerve ; Neuroma ; Sensation ; Thumb ; Tissue Donors

PURPOSE: There are multiple dependent variables commonly attributed to survival of replanted digits. The ischemia time is thought to be a clinically relevant factor. However, controversy exists as large hand centers have reported successful replant outcomes independent of ischemic time. In this study, we present a single institution experience on the effect of ischemia time on the survival of completely amputated digits. METHODS: A retrospective review of a single institution experience was performed. This cohort included all comers who had suffered complete amputation of a digit (Zone 2-4) and underwent replantation from 2003 to 2009. Demographic information as well as injury mechanism, ischemic time, and replantation outcome were recorded for each patient. Chi-square was used to analyze the result. RESULTS: Mean age was 35.5 years old(2-69). Mean replantation survival was 89.5%(37/317). Survival rates were 94, 88, and 88% in respective groups of 0~6, 6~12, of >12 hours of ischemia time. In chi-square analysis, there was no difference with p value of 0.257. No other independent patient factors showed statistically significant relationship to replant survival rate. In the group with longest ischemia time(12~18 hours) replant survival rate was 88% (37/42). CONCLUSION: Prolonged ischemia time is commonly believed to be a contributing factor for replant survival. However, our experience has shown that survival rate is uniform up to 18 hours of ischemia.
Amputation ; Cohort Studies ; Fingers ; Hand ; Humans ; Ischemia ; Replantation ; Retrospective Studies ; Survival Rate

BACKGROUND: Measuring grip and pinch strength is an important part of hand injury evaluation. Currently, there are no standardized values of normal grip and pinch strength among the Korean population, and lack of such data prevents objective evaluation of post-surgical recovery in strength. This study was designed to establish the normal values of grip and pinch strength among the healthy Korean population and to identify any dependent variables affecting grip and pinch strength. METHODS: A cross-sectional study was carried out. The inclusion criterion was being a healthy Korean person without a previous history of hand trauma. The grip strength was measured using a Jamar dynamometer. Pulp and key pinch strength were measured with a hydraulic pinch gauge. Intra-individual and inter-individual variations in these variables were analyzed in a standardized statistical manner. RESULTS: There were a total of 336 healthy participants between 13 and 77 years of age. As would be expected in any given population, the mean grip and pinch strength was greater in the right hand than the left. Male participants (137) showed mean strengths greater than female participants (199) when adjusted for age. Among the male participants, anthropometric variables correlated positively with grip strength, but no such correlations were identifiable in female participants in a statistically significant way. CONCLUSIONS: Objective measurements of hand strength are an important component of hand injury evaluation, and population-specific normative data are essential for clinical and research purposes. This study reports updated normative hand strengths of the South Korean population in the 21st century.
Cross-Sectional Studies ; Female ; Hand ; Hand Injuries ; Hand Strength ; Humans ; Male ; Pinch Strength ; Population Dynamics ; Reference Values

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