No abstract available.

Recently, there were many cases which was associated with bone defect in the limb and skin defect. We had performed vascularized osteocutaneous fibular transfer with microsurgical technique and experienced early bone union and simutsneous external wound healing. So we, authers, reviewed 12 cases of vascularized osteocutaneous fibular transfer which were performed to the extensive bone defect of the tibia and associated soft tissue injury. And the following remarkable results were obtained. 1. With the uncontrolled bone infection, the vascularized osteocutaneous fibular transfer was able to be performed and there was no non-union. 2. During the follow up period, the grafted fibula had been hypertrophied. 3. In the cases which the fibula were grafted to the defect after the segmental and partial excision of the tibia, in general, the partial weight bearing was able to be started from 3 months to 5 months after the operation, In the cases with segmental and complete excision of the tibia, the partial weight bearing was able to be started from 5 months to 7 month after the operation. 4. In adult, free fibula can be obtained and grafted as 20cm as long and the fibula was a good donor for extensive long bone defect as a compact bone; the skin flap with fibula can be obtained and grafted as 17 × 9cm as large in our experience. 5. In the vascularized osteocutaneous fibula transfer, the skin flap could be confirmed wheather the vascular anastomosis is patent or not as a monitor.
Adult ; Clinical Study ; Extremities ; Fibula ; Follow-Up Studies ; Humans ; Microsurgery ; Skin ; Soft Tissue Injuries ; Tibia ; Tissue Donors ; Transplants ; Weight-Bearing ; Wound Healing

PURPOSE: This study aims to examine the relationships among experiences of traumatic events, post-traumatic stress (PTS), and the needs for health promotion programs of 119 paramedics. METHODS: Experiences of traumatic events, PTS, and needs for health promotion programs were measured using a structured questionnaire. The subjects were 193 paramedics in Jeju Island. Data were analyzed using descriptive statistics, t-test and χ2 test. RESULTS: The most experienced event out of the 16 different traumatic events was ‘retrieve a suicide's body.’ A high-risk classification of PTS was observed in 36.2% of the subjects. The rates of experiences were higher than those of the actual needs for all 26 health promotion programs. The programs reported as highly needed by respondents were stress management (75.5%) followed by exercise (74.6%) and PTS management (72.5%). Subjects with longer career periods, a fire sergeant, perceived obesity, numerous experiences of traumatic events, and in the PTS risk group had a higher need for a stress management program. CONCLUSION: These findings indicate that a significant number of 119 paramedics experienced PTS. They also show that onsite strategic management is strongly required. In addition, implementation of health promotion programs based on the needs of 119 paramedics is highly needed.
Allied Health Personnel* ; Classification ; Fires ; Health Promotion* ; Humans ; Needs Assessment ; Obesity ; Surveys and Questionnaires

Laminin-1 is biologically active and can effect cellular proliferation, differentiation, migration, and apoptosis. In the central nervous system, neuronal cells are rarely reported to give positive reaction by laminin antibody staining. However, the original cell type which can produce the laminin molecule has not been well established. Since the neuronal cells of brain are derived from neuroectoderm, we thought that the neuronal cells should be able to produce the laminin molecules as other epithelial cells. In this study we aimed to explore whether the neuronal cells express the laminin chain mRNAs, and further to identify which types of laminin isoform are expressed at the specific sites of the brain structure. We found that neuronal cell was the important cell type in mouse brain, which could produce laminin isoforms. Although immunostainings disclosed reactivity of laminins in the basement membrane of capillaries as well as neuronal cells, mRNA expressions of laminins were intense only in the neuronal cells. It was relatively weak in the endothelial cells. Among neuronal cells the cortical cells of cerebrum, pyramidal cells of hippocampus, and Purkinje cells of cerebellum showed pronounced expression of laminin chain mRNA. Glial cells, especially astrocytes, were negative for laminin subtypes both in immunohistochemistry and in situ hybridization. Taken together, our data indicate that the neuronal cells of mouse brain actively produce laminin isoforms, and the resultant polymerized laminins are accumulated mainly in the basement membrane of capillaries. In conclusion, the results indicate that neuronal cells produce and utilize the different laminin chains to maintain the neurovascular environment of brain.
Animals ; Apoptosis ; Astrocytes ; Basement Membrane ; Brain* ; Capillaries ; Cell Proliferation ; Central Nervous System ; Cerebellum ; Cerebrum ; Endothelial Cells ; Epithelial Cells ; Hippocampus ; Immunohistochemistry ; In Situ Hybridization ; Laminin* ; Mice* ; Neural Plate ; Neuroglia ; Neurons* ; Polymers ; Protein Isoforms ; Purkinje Cells ; Pyramidal Cells ; RNA, Messenger

Intracranial nerve sheath tumors unrelated to the cranial nerve roots are extremely rare, and the origin of the tumors are debatable. We report a case of pathologically-proven neurofibroma inside the lateral ventricle. A 49-year-old man presented with headache of 6 months duration, urinary incontinence, visual disturbance and right hemiplegia. Brain CT scan showed a well defined isodense mass with homogenous contrast enhancement and marginal calcification. At surgery the tumor was found to be a 4cm-sized lobulated mass attached only to the choroid plexus. Histologically, the tumor masses consisted of fasciculating bundles of wavy spindle cells, with a considerable collagen laydown.
Brain ; Choroid Plexus ; Collagen ; Cranial Nerves ; Headache ; Hemiplegia ; Humans ; Lateral Ventricles ; Middle Aged ; Nerve Sheath Neoplasms ; Neurofibroma* ; Tomography, X-Ray Computed ; Urinary Incontinence

BACKGROUND: Left ventricular performance is one of the most important factors for the prognosis of congenital and acquired heart diseases. Measure of left ventricular performance such as chamber volume and ejection fraction are usually deemed most reiable when derived from cardiac catheterization data. Measurement of ventricular volume and ejection fraction by M-mode echocardiography may be compromised by segmental dysfunction or paradoxical septal motion. We compared ejection fraction derived from M-mode and two-dimensional echocardiographic methods to those derived from newly developed DCI (Digital Cardiac Imaging) system to determine the most accurate noninvasive technique for prediction these variables in children. METHODS: The ejection fraction measured by M-mode, Two-dimensional echocardiography was compared with the ejection fraction by DCI system in 22 patients who were admitted to the department of Pediatrics, Dong San Hospital during the period of 8 months from November 1992 to June 1993 for the evaluation of ventricular septal defect. RESULTS: M-mode measured ejection fraction correlated with Two-dimensional echocardiography measured ejection fraction(gamma=0.54). M-mode measuredd ejection fraction correlated with the DCI system measured ejection fraction(gamma=0.52). Two-dimensional echocardiography measured ejection fraction correlated well with the DCI system measured ejection fraction(gamma=0.88). CONCLUSION: 1) For ejection fraction, the best correlation with DCI was achieved by two-dimensional Simpson's method. 2) Two-dimensional Simpson's method appeared a safe and useful noninvasive method of evaluation left ventricular ejection fraction.
Cardiac Catheterization ; Cardiac Catheters ; Child ; Echocardiography* ; Heart Diseases ; Heart Septal Defects, Ventricular ; Humans ; Pediatrics ; Prognosis ; Stroke Volume*

BACKGROUND: Prenatal tongue development may affect oral-craniofacial structures, but this muscular organ has rarely been investigated. METHODS: In order to document the physiology of prenatal tongue growth, we histologically examined the facial and cranial base structures of 56 embryos and 106 fetuses. RESULTS: In Streeter's stages 13-14 (fertilization age [FA], 28 to 32 days), the tongue protruded into the stomodeal cavity from the retrohyoid space to the cartilaginous mesenchyme of the primitive cranial base, and in Streeter's stage 15 (FA, 33 to 36 days), the tongue rapidly swelled and compressed the cranial base to initiate spheno-occipital synchondrosis and continued to swell laterally to occupy most of the stomodeal cavity in Streeter's stage 16-17 (FA, 37 to 43 days). In Streeter's stage 18-20 (FA, 44 to 51 days), the tongue was vertically positioned and filled the posterior nasopharyngeal space. As the growth of the mandible and maxilla advanced, the tongue was pulled down and protruded anteriorly to form the linguomandibular complex. Angulation between the anterior cranial base (ACB) and the posterior cranial base (PCB) was formed by the emerging tongue at FA 4 weeks and became constant at approximately 124degrees-126degrees from FA 6 weeks until birth, which was consistent with angulations measured on adult cephalograms. CONCLUSIONS: The early clockwise growth of the ACB to the maxillary plane became harmonious with the counter-clockwise growth of the PCB to the tongue axis during the early prenatal period. These observations suggest that human embryonic tongue growth affects ACB and PCB angulation, stimulates maxillary growth, and induces mandibular movement to achieve the essential functions of oral and maxillofacial structures.
Adult ; Axis, Cervical Vertebra ; Embryonic Structures* ; Fetus* ; Humans ; Mandible ; Maxilla ; Mesoderm ; Parturition ; Physiology ; Skull Base ; Tongue*

PURPOSE: This study was done to analyze nursing students' attitudes to life-sustaining treatment by measuring their awareness of biomedical ethics and resulting attitude toward withdrawal of life-sustaining treatment. METHODS: This study was a descriptive research to assess the level of nursing students' awareness of biomedical ethics, attitude toward withdrawal of life-sustaining treatment, and correlations between these variables. After the nursing students signed a consent form they were assessed. Data collection was done from September 1 to October 25, 2016, and analyzed using SPSS 23.0 WIM Program. RESULTS: There was a negative correlation and significant difference between nursing students' awareness of biomedical ethics and attitude toward withdrawal of life-sustaining treatment. There was a significant correlation among attitude toward withdrawal of life-sustaining treatment and medical ethics, mortality ethics. CONCLUSION: The findings in the study indicate that it is necessary to provide nursing students with easy access to continuous education to help them establish an acceptable view of withdrawal of life-sustaining treatment.
Bioethics* ; Consent Forms ; Data Collection ; Education ; Ethics ; Ethics, Medical ; Humans ; Life Support Care ; Mortality ; Nursing* ; Students, Nursing

It is generally considered that enteral feeding is superior to parenteral nutritional support. Thus enteral meal should be given whenever patients have proper gastrointestinal function to take enteral feeding. Because the morbidity and mortality for surgical jejunostomy have been reported as high as 50% and 10% respectively, direct percutaneous endoscopic jejunostomy has been developed to reduce the morbidity and mortality. A 55-year-old male patient, who was suffering from dysphagia and oropharyngeal aspiration, was transferred to the division of gastroenterology to be done permanent enteral feeding. His stomach was resected (subtotal gastrectomy with billroth II anastomosis) due to peptic ulcer hemorrhage 10 years before. We performed direct percutaneous endoscopic jejunostomy without any complication. Herein, we report a successful case.
Deglutition Disorders ; Enteral Nutrition ; Gastrectomy* ; Gastroenterology ; Gastroenterostomy ; Humans ; Jejunostomy* ; Male ; Meals ; Middle Aged ; Mortality ; Nutritional Support ; Peptic Ulcer Hemorrhage ; Stomach

A 19 yar-old male patient was admitted to the department of neurology in Severance hospital beause of slowly progressive spastic paraparesis. On examination, dark brown skin color, sparse hair, spastic weakness and hypesthesia of lower extremities were noted. The laboratory studies showed high serum ACTH level with lowest normal limit of serum cortisol level. Brain MRI scan revealed high signal intensities in bilateral corticospinal tracts on T, Weighted images with gadolinium enhancement and T2eighted images. The results of three modal evoked potential studies(SEP. BAEP. VEP) were abnormal bilaterally. Nerve conduction studies and sural nerve biopsy suggested the presence of peripheral neuropathy.
Adrenocorticotropic Hormone ; Adrenoleukodystrophy* ; Biopsy ; Brain ; Evoked Potentials ; Gadolinium ; Hair ; Humans ; Hydrocortisone ; Hypesthesia ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Muscle Spasticity ; Neural Conduction ; Neurology ; Paraparesis, Spastic ; Peripheral Nervous System Diseases ; Pyramidal Tracts ; Skin ; Sural Nerve