Scalp and calvarium defects are caused by trauma, burn, tumor resection, or congenital diseases. We experienced a few cases of severe electrical burn of scalp and calvarium, but fourth-degree contact burn of scalp and calvarium is a rare case. A 67 years old man was presented with a 25% total body surface area contact burn. A 20 cm×15 cm thick eschar on the patient's scalp was observed. Among various techniques for scalp reconstruction, we planned fasciocutaneous transposition flap with split thickness skin graft for coverage of large defect. Considering aesthetically satisfactory outcome, we designed a fasciocutaneous transposition flap including the hair-bearing areas. We additionally used skin graft for uncovered surrounding areas. There were no flap necrosis, graft loss, or any other surgical complications after the surgical flap and skin graft. At 6-month follow-up, the operation site was stable. The patient satisfied with functional and aesthetical outcomes, so we report this case.
Body Surface Area ; Burns* ; Follow-Up Studies ; Humans ; Necrosis ; Scalp* ; Skin ; Skull* ; Surgical Flaps ; Transplants

PURPOSE: Skin graft may fail for a number of reasons. Hematoma or seroma formation prevents graft adherence. Traditionally tie-over dressing has been used in skin graft fixation, but skin graft in convex and narrow place like fingers or toes, tie-over dressing is hard to be applied. And Vaseline gauze over graft often adheres to graft by exudate into gauze fibers and hardening, and may cause damage to graft in dressing change. We report successful results of using silicone net dressing in fixation of split thickness skin graft over these place. METHODS: After skin graft, the silicone net, Mepitel(R) (Molnlycke Health Care, Box 13080, SE-402 52 Goteborg, Sweden) was applied over the graft followed saline wet gauze dressing in 25 patients. 13 cases were on finger, 8 cases were on foot or toes, 4 cases were on anterior chest. RESULTS: In 22 cases, there were no hematoma or seroma formation, Mepitel(R) maintained 5 days after skin graft. And then, Mepitel(R) was removed from the graft. In 3 cases, there were hematoma formation, Mepitel(R) was removed at 3 days after skin graft. In all cases, grafts were taken well without maceration or skin eruption. CONCLUSION: The silicone net, Mepitel(R), is dressing material made of silicone gel bound to a pliable polyamide net, and it can provide uniform pressure to the graft, even in convex and narrow place. And net like structure allows the exudates of the wound to pass freely into the secondary absorbent dressing and easier to remove from the grafts than Vaseline gauze. We think that the use of a Mepitel(R) is a efficient tool for securing skin grafts.
Bandages* ; Delivery of Health Care ; Exudates and Transudates ; Fingers ; Foot ; Hematoma ; Humans ; Nylons ; Petrolatum ; Seroma ; Silicone Gels* ; Skin* ; Thorax ; Toes ; Transplants* ; Wounds and Injuries

PURPOSE: Skin graft is useful treatment in burn wound. The major disadvantage of traditional skin graft is related to recipient site scarring and donor site morbidity. Then we present our successful experience of using skin graft after advancement flap. METHODS: The study is based on 22 patients who has deep 2nd burn wound with eschar and 3rd degree burn wound. We performed split-thickness skin graft in 17 patients, and fullthickness skin graft in 5 patients. After undermining of wound margin about 1.3 cm~4 cm, we performed suture of wound marginal skin and subcutaneous tissue with absorbable suture materials. Then we harvested skin according to reduced wound size, and we applied donor skin in recipient area. RESULTS: The skin graft area of the 17 patients who had split skin-thickness graft showed a decline of 25% compared with that of the initial burn wound. 5 patents who had full-thickness skin graft also showed a decrease of 10% in the skin graft area compared with that of the initial burn wound. All Grafts were well taken in 22 patients without skin loss. By observing the progress 12 to 15 months after the operation, minor hypertrophic scar on the boundary of grafted skin area was observed in the 2 patents and hypertrophic scar or contracture was not seen in all 22 patients. CONCLUSION: Skin graft after advancement flap can be used as a treatment in deep 2nd degree and 3rd degree burn wound. Compared with traditional skin graft, the result seems to be good cosmetically and functionally.
Burns* ; Cicatrix ; Cicatrix, Hypertrophic ; Contracture ; Humans ; Skin* ; Subcutaneous Tissue ; Sutures ; Tissue Donors ; Transplants* ; Wounds and Injuries

Accumulated evidence suggests that sporadic cases of Alzheimer's disease (AD) make up more than 95% of total AD patients, and diabetes has been implicated as a strong risk factor for the development of AD. Diabetes shares pathological features of AD, such as impaired insulin signaling, increased oxidative stress, increased amyloid-beta (Aβ) production, tauopathy and cerebrovascular complication. Due to shared pathologies between the two diseases, anti-diabetic drugs may be a suitable therapeutic option for AD treatment. In this article, we will discuss the well-known pathologies of AD, including Aβ plaques and tau tangles, as well as other mechanisms shared in AD and diabetes including reactive glia and the breakdown of blood brain barrier in order to evaluate the presence of any potential, indirect or direct links of pre-diabetic conditions to AD pathology. In addition, clinical evidence of high incidence of diabetic patients to the development of AD are described together with application of anti-diabetic medications to AD patients.
Alzheimer Disease ; Blood-Brain Barrier ; Encephalitis ; Humans ; Incidence ; Insulin ; Neuroglia ; Oxidative Stress ; Pathology ; Risk Factors ; Tauopathies

Missing observations are common in medical research and health survey research. Several statistical methods to handle the missing data problem have been proposed. The EM algorithm (Expectation-Maximization algorithm) is one of the ways of efficiently handling the missing data problem based on sufficient statistics. In this paper, we developed statistical models and methods for survey data with multivariate missing observations. Especially, we adopted the Em algorithm to handle the multivariate missing observations. We assume that the multivariate observations follow a multivariate normal distribution, where the mean vector and the covariance matrix are primarily of interest. We applied the proposed statistical method to analyze data from a health survey. The data set we used came from a physician survey on Resource-Based Relative Value Scale(RBRVS). In addition to the EM algorithm, we applied the complete case analysis, which used only completely observed cases, and the available case analysis, which utilizes all available information. The residual and normal probability plots were evaluated to access the assumption of normality. We found that the residual sum of squares from the EM algorithm was smaller than those of the complete-case and the available-case analyses.
Biostatistics ; Dataset ; Health Surveys* ; Models, Statistical ; Relative Value Scales

The nimodipine, calcium-channel blocker, is known to specific to brain tissue and effect on the ischemic stroke. To evaluate the efficacy and tolerability of nimodipine, we studied the 37 patients with Organic Brain Syndrome(OBS) who admitted to St. Mary's Hospital from January to August, 1989. We followed up for 12 weeks of their 18 items of neurologic outcome. The results and conclusion were as follows: 1) The pretreatment SCAG(Sandoz Clinical Assessment-Geriatric Scale) was used as a base-line measurement and the efficacy of the therapy was evaluated entirely in terms of changes in SCAG after 3, 6, 9 and 12 weeks of treatment. The total score was changed with meaningful improvement(p<0.01). 2) Among the 18 items of symptoms, the confusion, the level of alertness, the memory and the orientation were the area that have showed the most improvement. 3) No effect on heart, blood chemistry or other side effect was noted during medication. 4) We also found that those improvement has no specific relation to age, sex and causes of OBS. These result indicate that nimodipine has a possible therapeutic benefit in patients with OBS, especially who have the symptoms of confusion and impaired recent memory. These result should encouraged us to do further study such as double blind placebo in order to clarify the genuine pharmacological efficacy.
Brain* ; Chemistry ; Heart ; Humans ; Memory ; Nimodipine* ; Stroke

Background: Hematopyometra, an accumulation of bloody, purulent material in the ute-rine cavity, is a relatively uncommon event. The incidence is almost 0.01~0.5% in gynec-ologic patients. The most common cause of this condition is interference with the normal drainage of the uterus;endocervical obstruction by malignant disease. Other obstructive causes are the benign tumors in uterus, senile endocervicitis, long-term use of intrauterine device, cervical occlusion after surgery or radiation, intrauterinel infection, and congenital cervical anomaly. Methods: This report was performed to evaluate the hematopyometra patients, who were diagnosed and treated at Catholic University Medical College Hospitals from 1991 to 1995. Forty cases of hematopyometra were retrospectively reviewed by charts, radiologic and pathologic findings concerning with the clinical features. Results: 1) The most frequent age of hematopyometra patients was 50 to 59 years(45 %) and mean age was 63 years old. 2) Four patients(10 %) were at premenopausal period, and remaining 36 patients(90 %) were at the period of menopause(p<0.01). 3) The clinical manifestations of the patients were variable;profuse vaginal discharge(75 %), vaginal ble- eding or spotting(40 %), and lower abdominal pain(30 %). 4) The associating medical cond- itions or possible risk factors of hematopyometra are senile atrophic change(52.5 %), IUD inserted condition(25 %), genital malignant diseases(17.5 %), and uterine myoma(5 %). 5) The bacterial infection are frequently associated with hematopyometra and the causative ag ents are streptococci(50 %), E. coli(42 %), and mixed type(17 %). 6) Eight cases of them showed generalized peritonitis in the preoperative clinical course and three patients had been serious condition by septicemia. 7) The genital malignant diseases are associated with he- matopyomerta in 7 cases(17.5 %) of them(cervical cancer;4 cases, endometrial cancer;2 cases, and ovarian cancer;1 case). 8) All the cancer patients could be followed-up at le-ast for 2 years. Two patients, who were diagnosed for cervical cancer in the stage IIb and III, died of the persistent or recurrent disease in the period of following-up after the pri-mary treatment.
Bacterial Infections ; Drainage ; Female ; Humans ; Incidence ; Intrauterine Devices ; Menopause ; Middle Aged ; Peritonitis ; Premenopause ; Retrospective Studies ; Risk Factors ; Sepsis ; Uterine Cervical Neoplasms ; Uterus*

From August 1998 to June 2005, we treated 5 children (7 cases) who suffered with traumatic dislocation of hip. The mean follow-up period was 4.1 years (range: 1~8 years). Acceptable reduction was achieved in all cases by first closed reduction. The complications were 2 redislocations in 2 patients, respectively. Closed reduction is an effective method for treating traumatic dislocation of the hip in children and long term follow-up should be performed for detecting late-onset complications such as avascular necrosis, growth disturbance and traumatic osteoarthritis.
Child* ; Dislocations ; Follow-Up Studies ; Hip Dislocation* ; Hip* ; Humans ; Necrosis ; Osteoarthritis

STUDY DESIGN: A retrospective review of prospectively collected data. PURPOSE: To introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability. OVERVIEW OF LITERATURE: Although spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has rarely been reported. METHODS: In total, 103 patients who underwent single-level ACDF surgery with the SDD method were enrolled. The primary outcome measure was the accuracy of the SDD method. The secondary outcome measures were the mean SDD value at each cervical level from the cranial margin of the sternum in the neutral and extension positions of the cervical spine and the inter- and intra-observer reliability of the SDD outcome determined using repeated measurements by three orthopedic spine surgeons. RESULTS: The SDD accuracy (primary outcome measure) was indicated in 99% of the patients (102/103). The mean SDD values in the neutral-position magnetic resonance imaging (MRI) were 108.8 mm at C3–C4, 85.3 mm at C4–C5, 64.4 mm at C5–C6, 44.3 mm at C6–C7, and 24.1 mm at C7–T1; and those in the extension-position MRI were 112.9 mm at C3–C4, 88.7 mm at C4–C5, 67.3 mm at C5–C6, 46.5 mm at C6–C7, and 24.3 mm at C7–T1. The Cohen kappa coefficient value for intra-observer reliability was 0.88 (excellent reliability), and the Fleiss kappa coefficient value for inter-observer reliability as reported by three surgeons was 0.89 (excellent reliability). CONCLUSIONS: Based on the results of the present study, we recommend performing ACDF surgery using the SDD method to determine the skin level for approaching the surgical cervical segment without fluoroscopic guidance.
Cervical Vertebrae ; Diskectomy* ; Female ; Fluoroscopy* ; Humans ; Magnetic Resonance Imaging ; Methods* ; Orthopedics ; Outcome Assessment (Health Care) ; Prospective Studies ; Retrospective Studies ; Skin* ; Spinal Fusion ; Spine ; Sternum ; Surgeons

BACKGROUND: The objects of this study is to compare the clinical aspects and characteristics of the sternal fracture between non-old aged and the old aged. METHODS: This study is based on 105 patients who were diagnosed as a sternal fracture at the emergency center of Chunchon Sacred Heart Hospital from January of 2001 to June of 2007. RESULTS: The overall clinical presentations of sternal fracture of the old aged are similar to that of non-old aged. There were some differences in the patterns of spinal fracture occurred with sternal fracture between non-old aged and the old aged. In non-old aged group, there were 7 patients(8.6%), who had the facture of spine along with sternal fracture, and there were 4 male and 3 females. In the old aged group, there were 4 male and 4 female patients out of 8 patients. There were 2 female patients who had both thoracic and lumbar spinal fractures in the old aged group. CONCLUSION: There were many cases of injury which were accompanied with the sternal fracture. When the two groups are compared, the spinal facture were more often in the old aged group. Especially, the fracture of lumbar spine occurred more frequent in the old aged group.
Emergencies ; Female ; Gangwon-do ; Heart ; Humans ; Male ; Spinal Fractures ; Spine ; Sternum