The skin defects or sensory impairment of the fingers, especially at the critical area for prehension(tips of thumb, index and middle fingers) should be reconstructed for the better function of hand. In our department, we performed neurovascular island pedicle flap transfer for the purpose of reconstruction of sensibility and skin defect simultaneousely to the critical area. 1. Since 1978, we had performed neurovascular island pedicle flap transfer in 14cases, among which 9 cases were followed for more than one year. 2. The operation was performed for the reconstruction of thumb in 8 cases, and index in 4 cases. The most common cause of injury was crushing by machine(8 cases). 3. The island flap was transferred from middle finger(9 cases) and from ring finger(4 cases). 4. Recovery of the protective sensation at the recipient sites was good or fair after one year, but reorientation and two point discrimination were poor. 5. Cold intolerance was developed in 3 cases and callosity was formed in 2 cases. 6. In all cases, the transferred flaps were good in circulation status and durability. 7. It is considered that the neurovascular island pedicle flap is an accepted method of restoring skin coverage as well as sensation to a localized tactile area in the hand.
Callosities ; Discrimination (Psychology) ; Fingers ; Hand ; Methods ; Sensation ; Skin ; Thumb

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

No abstract available.
Acromioclavicular Joint* ; Acromion* ; Dislocations*

In the surgical trestment of unstable Iumbar spinal disorders, various methods of instrumentstion have been used for stabilization of spine, correction of deformity and reduction of fracture, despite of their technical demands. This paper reports the results of 30 patients of Cotrel-Dubousset instrumentation and posterolateral fusion for the lumbar spinal disorders associated with instability. The results obtained were as follows:l. Of the 30 cases, males were 15 cases(50%), females were 15 cases(50%) and average age of the patients was 42 yesrs ranging from 16 to 65 years. 2. Types of the disorders were spondylolisthesis in 16, failed back syndrome in 6, spondylolysis in 2, spinal canal stenosis in 2, scoliosis associated with degenerative spondylitis in 2, and burst fracture in 2 cases. 3. Among the 28 cases, 11 cases were excellent and 14 cases were good in Steffee's criteria (2 cases of burst fractures were excluded). 4. In spondylolisthesis, the average percentage of slippage was changed from 20% preoperatively to 5% postoperatively and 5.2% at the final follow-up. The initial correction rate was 75% and the loss of correction was not significant in follow-up study. 5. The patients with neurological claudication were permitted ambulation from postoperative 3rd day. In the final follow-up, the 8 patients(80%) could walk for more than 1 hour without pain. 6. The complications were relatively few(3 cases of hematoma, 2 cases of marginal sloughing of skin with superficial infection and one case of transient dysuria). In this study, this method seemed to be superior to others for the treatment of lumbar spinal disorders associated with instability especially degenerative spinal disorders in the respect of stability. Simultaneously, it provides immediate postoperative rehabilitation without rigid external support.
Congenital Abnormalities ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Male ; Methods ; Rehabilitation ; Scoliosis ; Skin ; Spinal Canal ; Spine ; Spondylitis ; Spondylolisthesis ; Spondylolysis ; Walking

18 humerus fractures in multiple injured patients were treated by closed intramedullary Ender nailing from June 1987 to June 1988. Follow-up over 3 months were obtained for 11 patients(11 fractures) and results were as follows : 1. Male was 10 in 11 cases and age was widely distributed to that of active life. 2. Trauma was the main cause of injury. 3. Ender nails were inserted through retrograde of entry in 6 cases and antegrade in 5 cases. 4. Coaptation splint was removed at postop. 3rd day and active joint exercise was started. 5. The average time of initial callus formation was post injury 19.2 days and that of solid periosteal callus bridge formation was post injury 7.5 weeks. 6. Early joint exercise, early mobilization of patient, ease of general care, small amount of blood loss, etc. were thought to be the adventages of closed Ender intramedullary nailing for humerus fractures especially in multiple injured patients.
Bony Callus ; Early Ambulation ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Humerus ; Joints ; Male ; Splints

No abstract available.
Tuberculosis, Miliary*

No abstract available.
Pulmonary Aspergillosis*

No abstract available.
Colorectal Neoplasms* ; Epidermal Growth Factor* ; Humans ; Receptor, Epidermal Growth Factor*

Heart failure (HF) is a chronic condition affecting millions of people worldwide. While the cardinal manifestations of HF are related to the cardiovascular system, it has become progressively evident that mild cognitive impairment (MCI) is also a significant complication of the disease. In fact, a significant number of patients with HF may experience MCI, which can manifest as deficits in attention, memory, executive function, and processing speed. The mechanisms responsible for cognitive dysfunction in HF are intricate and multifactorial.Possible factors contributing to this condition include decreased cerebral blood flow, thrombogenicity associated with HF, systemic inflammatory conditions, and proteotoxicity.MCI in HF has significant clinical implications, as it is linked to poorer quality of life, increased morbidity and mortality, and higher healthcare costs. Additionally, MCI can disrupt self-care behaviors, adherence to medication, and decision-making abilities, all of which are crucial for effectively managing HF. However, there is currently no gold standard diagnostic tool and follow-up strategy for MCI in HF patients. There is limited knowledge on the prevention and treatment of MCI. In conclusion, MCI is a common and clinically important complication of HF. Considering the substantial influence of MCI on patient outcomes, it is imperative for healthcare providers to be cognizant of this issue and integrate cognitive screening and management strategies into the care of HF patients.

No abstract available.
Dislocations* ; Shoulder*