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

A case of unilateral multicystic renal dysplasia was reported in view of rarity, and a review of literature 23-year-old female was admitted to Kyung Hee University Hospital with a complaint of urinary incontinence. An excretory urogram revealed non-visualization of the right kidney. The right ureter had opening at the 2 cm above the vaginal introitus. The resected right kidney revelaed multilobulated outer surface with multiloculated cystic struture on cut surface. The associated anomaly was uterine didelphy. The condition was treated by nephroureterectomy.
Female ; Humans

A case of unilateral multicystic renal dysplasia was reported in view of rarity, and a review of literature 23-year-old female was admitted to Kyung Hee University Hospital with a complaint of urinary incontinence. An excretory urogram revealed non-visualization of the right kidney. The right ureter had opening at the 2 cm above the vaginal introitus. The resected right kidney revelaed multilobulated outer surface with multiloculated cystic struture on cut surface. The associated anomaly was uterine didelphy. The condition was treated by nephroureterectomy.
Female ; Humans

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

PURPOSE: To investigate the effects of intravitreal bevacizumab injection on diabetic macular edema (DME) of different types classified using Optical Coherence Tomography (OCT). METHODS: A total of 82 eyes with refractory DME were enrolled. The DME was classified into diffuse, cystoid, or serous type based on the OCT findings. All cases had received an intravitreal injection of 1.25 mg bevacizumab each month for three months. Foveal thickness, macular volume, and best corrected visual acuity (BCVA) were measured before and one month after the injection, and the interval changes in these parameters were compared. RESULTS: The types of DME were classified as follows: diffuse macular edema 50%, cystoid macular edema 31.7%, and serous macular detachment 18.3%. Foveal thickness and total macular volume after intravitreal bevacizumab injection decreased in all types, and the cystoid and serous types showed better response than did the diffuse type with regard to foveal thickness. However, there were no significant differences in the extent of the change in total macular volume or BCVA among the three types of DME. CONCLUSIONS: There were differences in the therapeutic effects of intravitreal bevacizumab injection among the different types of DME classified using OCT. These differences may be associated with the stabilizing effect of the bevacizumab. This effect was stronger with regard to vascular permeability, the primary factor in the pathogenesis of the cystic and serous types, than with regard to leakage from the microaneurysm, the primary factor in the pathogenesis of the diffuse type. Practical application of bevacizumab to eyes with different DME types will help in further evaluating intravitreal bevacizumab injection as a treatment option for DME.
Antibodies, Monoclonal, Humanized ; Capillary Permeability ; Eye ; Intravitreal Injections ; Macular Edema ; Tomography, Optical Coherence ; Visual Acuity ; Bevacizumab

OBJECTIVE: To determine the fetal aneuploidy in fetal blood cells from cordocentesis. METHODS: We analyzed their karyotype and performed fluorescence in situ hybridization(FISH) for chromosome 18, 21, X, and Y in 14 cases of fetal blood cells from cordocentesis at Department of Obstetrics & Gynecology, College of Medicine, Seoul National University and Hamchoon Women's Clinic. RESULTS: In all cases we obtained the consistent results in both methods and were able to rapidly detect aneuploidy in uncultured fetal blood cells using FISH before karyotyping with culture for 48 hr. The averages for accuracy of FISH were from 84.6 % to 93.9%. CONCLUSION: In this study we suggest that the rapid detection in uncultured fetal blood using FISH is possible and that this diagnostic method will be clinically useful when rapid result would be demanded.
Aneuploidy* ; Chromosomes, Human, Pair 18 ; Cordocentesis ; Fetal Blood* ; Fluorescence* ; Gynecology ; In Situ Hybridization* ; Karyotype ; Karyotyping ; Obstetrics ; Seoul

FISH is suggested as a possible method to detect the numerical and structural abnormalities of chromosomes in interphase nucleus. We performed this study to discuss the clinical usefulness of FISH in uncultured amniocytes and to set up the cut-off value for further study. We collected amniotic fluid samples from patients whose chromosome studies were recommended due to screen positive for Down and Edword syndrome in triple marker test using maternal serum. The centromeric probe for chromosome 18 and the locus-specific probe for chromosome 21 were used and the results were compared to their karyotypes. We could find 2 cases of trisony 21 and 2 cases of trisony 18 and the other cases represented normal karyotypes. The accuracies were 91% for disomy 18, 89% for trisomy 18, 92% for disomy 21 and 88% for trisomy 21. Therefore FISH technique is a possible method to detect the chromosomal abnormalities in uncultured amniocytes and the use of locus-specific probe for chromosome 21 would be more useful for detecting the aneuploidy of chromosome 21 than 13/21 centromeric probe.
Amniotic Fluid ; Aneuploidy ; Chromosome Aberrations ; Chromosomes, Human, Pair 18 ; Chromosomes, Human, Pair 21 ; Down Syndrome* ; Female ; Fluorescence* ; Humans ; In Situ Hybridization* ; In Situ Hybridization, Fluorescence ; Interphase ; Karyotype ; Trisomy

OBJECTIVE: Our purpose was to identify the age-related inceased risks of the elderly gravida over 35 or 40 years at delivery by clarifying the effects of age and parity, their combination, and their interaction and the relationships of other complications. METHODS: We have made meta analysis about general and clinical characteristics of elderly gravida over the aged 35 or 40 years, based on the 7 domestic theses since 1996 year at the department of Obstetrics and Gynecology. RESULTS: The results were obtained as follows; In elderly gravida over the aged 35 or 40 years at delivery, maternal and neonatal outcomes were generally good, but in study group, there were a high incidence of gestational (preterm delivery, fetal presentation, pregnancy-induced hypertension, gestational diadetes, placenta previa, premature rupture of membranes) complications, uterine myoma during pregnancy and low birth weight in neonate after delivery. CONCLUSION: The increased risks of the elderly gravida over the aged 35 or 40 years at delivery may have been overshadowed by the previous focus on the elderly nullipara. In spite of high incidence of maternal morbidity, the overall maternal and neonatal outcomes were generally good. It is important to recognize what is more important in age-related pregnant-risks of the elderly gravida over the aged 35 or 40 years at delivery to appropriate counsel and manage this group of patients. This informations may be helpful for counsel in elderly gravida over the aged 35 or 40 years who are considering pregnancy.
Aged* ; Female ; Gynecology ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Labor Presentation ; Leiomyoma ; Obstetrics ; Parity ; Placenta Previa ; Pregnancy* ; Rupture