The development of the microvascular surgery revolutionalized the reconstructive surgery of the lower ext tremity. Especially, the defects of the heel and sole, the weight bearing area, were quite difficult and complicate to reconstruct by conventional methods. Many papers reported successful resurfacing the heel pad by free cutaneous or myocutaneous flaps. However, only few reports were conceming the late results of the reconstructed free flaps. The authors studied the histological and histochemical changes of the free flaps under the weight bearing stress in 10 cases. 1. The authors reconstructed 10 cases of the heel pad defects by dorsalis pedis free Aaps (5 cases) and latissimus dorsi myocutaneous flaps(5 cases). 2. Before transfer, the homy layer was very thin(about 0.16–0.2 mm) and had an arrangement of basket-weave pattem in both flaps. Until one year after transfer, this layer was wom out (0.02–0.08mm) However, after one year, this layer became thick (0.05–0.7 mm) and the arrangement was compact in both free flaps. 3. The granular and prickle cell layers were also increased in thickness after one year. 4. In the suprabasilar area, friction blisters were observed before one year, especially in latissimus dorsi myocutaneous flap. However, they slowly disappeared after one year and then the epidermis was stabilized. 5. In the dermis, the contents of the amyloid and acid mucopolysaccharides were increased up to the level of those of the normal heel pad in both flaps. 6. As a conclusion, the transferred free flaps were in distress before one year. But after one year, they began to adapt well histologically and histochemically to the weight bearing stress.
Amyloid ; Blister ; Dermis ; Epidermis ; Follow-Up Studies ; Free Tissue Flaps ; Friction ; Glycosaminoglycans ; Heel ; Myocutaneous Flap ; Superficial Back Muscles ; Weight-Bearing

With the introduction of electronic medical records (EMRs), it has become possible to accumulate massive amounts of qualitative medical data. As such, EMRs have become increasingly used in clinical decision support systems (CDSSs). While CDSSs aim to reduce medical errors normally occurring in the process of treating patients by physicians, technical maturity and the completeness of CDSSs do not meet standards for medical use yet. As data further accumulates, CDSS algorithms must be continuously updated to allow CDSSs to perform their core functions. Doing so, however, requires extensive time and manpower investments. In current practice, computational systems already perform a wide variety of functions in medical settings to allow medical staff to focus on other tasks. However, no prior research has evaluated the potential effectiveness of future CDSSs nor analyzed possibilities for their further development. In this article, we evaluate CDSS technology with the consideration that medical staff also understand the core functions of such systems.

No abstract available.
Fetus*

Primary hydronephrosis due to UPJ obstruction is not infrequent urologic disorder. The causes of the obstruction art categorized into extrinsic, intrinsic and ureterovascular abnormalities. The most important thing is accurate evaluation of the dynamic physiology of UPJ with the X- ray findings. We have experienced 16 cases of pyeloplasty during the last 10 years. We reported the evaluations of the cases with review of the articles. Results were. 1. Of these 16 cases, 13 were male and 3 were female and 11 were left and 5 were right hydronephrosis. 4 were children and 9 were 3rd. and 4th. decades 2. IVP, RGP, Ultrasonography and diuretic renogram were done preoperatively 3. Pyeloplasty were done by the dismembered in 13, Culp spiral flap in 2 and pyelopyeloplasty in 1. 4. Indigocarmin test, AGP, fluoroscopy and Whitaker test were done postoperatively. 5. There were improvement in 12 cases but failed in 3 cases.
Child ; Female ; Fluoroscopy ; Humans ; Hydronephrosis ; Male ; Physiology ; Ultrasonography

Among many causes of calcium containing urinary stones, the hypercalciuria associated with normocalcemia is the most common one. Absorptive hypercalciuria and renal hypercalciuria constitute two major forms of idiopathic hypercalciuria. According to Coe et al., a renal leak of calcium and secondary hyperparathyroidism are present in renal hypercalciuria but not in absorptive hypercalciuria. It has been suggested that fasting urinary cAMP may provide a measure of parathyroid function. So determination of fasting urinary calcium and cAMP may be useful in the differentiation of the two major forms of idiopathic hypercalciuria. We performed the study to evaluate the significance of urinary calcium and cAMP in the determinating the types of hypercalciuria. Calcium metabolism studies and urinary cAMP determination were done in 28 in-patients with urinary stones under usual diet and fasting state. The results were as followings: 1. Among 28 patients, 15 patients had renal hypercalciuria, 6 had absorptive hypercalciuria and 7 had normocalciuria. 2. On usual diet, 24-hour urine cAMP level was 3.815+/-0.560 nmol/mg creatinine in renal hypercalciuria, 3.508+/-1.253 nmol/mg creatinine in absorptive hypercalciuria and 3.202+/-0.980 nmol/mg creatinine in normocalciuric patients. 3. On fasting state, 2-hour urine cAMP level was 4.611+/-2.591 nmol/mg creatinine in renal hypercalciuria, 4.304+/-3.173 nmol/mg creatinine in absorptive hypercalciuria and 2.400+/-1.080 nmol/mg creatinine in normocalciuric patients. 4. urinary cAMP on usual diet and fasting condition did not differ significantly among 15 renal and 6 absorptive hypercalciuric patients. (t-value; 0.82 and 0.22, respectively, p>0.1)
Calcium ; Creatinine ; Diet ; Fasting ; Humans ; Hypercalciuria ; Hyperparathyroidism, Secondary ; Metabolism ; Urinary Calculi*

No Abstract Available.
Cytomegalovirus* ; Enzyme-Linked Immunosorbent Assay* ; Humans*

Complication of transurethral prostatic resection is hemorrhage, water intoxication, urethral stricture, perforation of bladder neck and surgical capsule, urinary incontinence . and infection. Hemorrhage is the most usual complication of TURP. Measurement of blood loss during TURP is very difficult because of dilution of blood with irrigating fluid and is very important to management of patient during and after surgery because its objectives are elderly patient. We studied the blood loss during TURP in 41 patients from Jan., 1984 to June, 1985, but 6patients were excluded because blood transfusion was performed during TURP by recognition of massive blood loss. Blood loss was measured in 35 cases by spectrophotometer used benzidine-heme color reaction. Following results were obtained. 1. Blood loss during TURP per time was 329+/-241 ml (Mean+/-S.D.) 2. Resection time was 71+21 min (Mean+/-S.D.) and blood loss per minute was 4.61 ml. Correlation coefficient between resection time and blood loss was +0.12 and was not significant. 3. Resected prostatic chip weight was 17.6+/-7.3 gm(Mean+/-S.D.) and blood loss per gram was 18.7 ml. Correlation coefficient between resected weight and lood loss was +0.29 and was significant weakly. 4. Irrigation fluid was used 22.2+8.l L (Mean+/-S.D.) and blood loss per liter was 14.8ml. Correlation coefficient between irrigation fluid and blood loss was +0.32 and was significant weakly.
Aged ; Blood Transfusion ; Hemorrhage ; Humans ; Neck ; Transurethral Resection of Prostate* ; Urethral Stricture ; Urinary Bladder ; Urinary Incontinence ; Water Intoxication

Urinary stones are mainly calcium stones and over a half of calcium stone patients are hypercalciuric. And about half of calcium stones are thought to be recurrent in 5 years. Renal tubular acidosis and hyperparathyroidism are the well known causes of the hypercalciuria but majority was categorized as the idiopathic hypercalciuria. Recently, metabolic derangements of idiopathic hypercalciuria were identified and classified according to responses to the calciums restriction, fasting and loading. And reasonable treatments were tried to prevent the recurrence according to the types and notable results were reported. We have performed metabolic study of calcium nephrolithiasis in 50 patients since June 1983. The results were as the followings: 1. In 31 stone analysis, 29 were calcium stones. 14 were calcium oxalate, 4 were calcium phosphate, 10 were calcium oxalate and phosphate and one was calcium oxalate and magnesium ammonium phosphate. 2. 24 of 50 patients were hypercalciuria. 3. One was resorptive type: In usual diet, serum Ca, P, PTH were 13.4 mg%, 2.9mg %, 6053 pg/ ml respectively and urine Ca was 806 mg/day. In fasting, urine Ca was 1.00 mg/mg of urine creatinine 4. 6 were renal type: In usual diet, serum Ca, P, PTH were 9.0+/-0.4 mg%, 3.8+/-0.4 mg%, 535+/-379pg /ml respectively and urine Ca was 226+/-75 mg/day. In fasting, urine Ca was 0.160+/-0.032 mg/ mg of urine creatinine. 5. 2 were absorptive type I : Urine Ca was 254 mg/day in usual, 204 mg/day in restriction, 0.087mg /mg of urine creatinine in fasting and 0.229 mg/mg of urine creatinine in loading. 6. 3 were absorptive type II : Urine Ca was 321+/-96 mg/day in usual, 164+/-18 mg/day in restriction, 0.096 mg/mg of urine creatinine in fasting and 0.215 mg/mg of urine creatinine in loading. 7. 6 were hyperuricosuric and 6 were unclassified hypercalciurias.
Acidosis, Renal Tubular ; Ammonium Compounds ; Calcium Oxalate ; Calcium* ; Creatinine ; Diet ; Fasting ; Humans ; Hypercalciuria ; Hyperparathyroidism ; Magnesium ; Nephrolithiasis* ; Recurrence ; Urinary Calculi

Accurate analysis of urinary calculi is fundamental for study of the etiology of stone formation and essential for treatment of urinary stone and its prevention. Among various methods for stone analysis, infrared spectroscopy analysis may be an ideal method to determine the accurate composition of urinary calculi by simple procedure in a short time. We have analyzed 100 urinary calculi by infrared spectroscopy with KBr tablet method. Stones were obtained from the patients visited our hospital during the period from January, 1980 to December, 1981. The following results were obtained: 1. Mixed stone (68%) is more common than pure stone (32%) . The most common type of calculus is calcium oxalate-tribasic calcium phosphate (57%) . The common type of component is calcium oxalate (47.3%) . 2. Calcium oxalate and tribasic calcium phosphate are contained most frequently in renal, ureteral and bladder stones. 3. Uric acid and cystine stones are found in acid urine, and most of magnesium ammonium phosphate and tribasic phosphate stones were found in alkaline urine. Calcium oxalate stones are found in urine with wider range of pH. 4. 30 of 100 patients have bacteriuria on culture. 10 of 13 patients with struvite stones showed bacteriuria and most of them are urea-splitting organisms.5. 5 cases of 16 laminated calculi contain the different components in nucleus and outer layer.
Ammonium Compounds ; Bacteriuria ; Calcium ; Calcium Oxalate ; Calculi ; Cystine ; Humans ; Hydrogen-Ion Concentration ; Magnesium ; Spectrum Analysis* ; Ureter ; Uric Acid ; Urinary Bladder Calculi ; Urinary Calculi*

No abstract available.