Microsurgical compoeite tissue transplantation to date has contributed to reconstructive surgery by expediting transfer of large blocks of tissue. We have performed the first successful transplantation of microneurovascular tendocutaneous free flap from the dorsum foot to the defect of dorsum hand including extensor tendons. We considered the free flap with extensor tendons from the dorsum foot was the best donor site for functional recovery of the defect of dorsum hand. Two cases of tendocutaneous free flap transplantation were performed at the Department of Orthopedic Surgery of Hanyang University Hospital, and satisfactory results were obtained.
Foot ; Free Tissue Flaps ; Hand ; Humans ; Orthopedics ; Tendons ; Tissue Donors ; Tissue Transplantation ; Transplants

There were many acceptable theories, which described the etiology, incidence, classification, operation time and operative method for the congenital hand anomalies, but so much troublesomes in these aspects were remained. So authors reviewed 57 cases in 49 patients with the congenital hand anomalies, managed at Department of Orthopaedic Surgery, Hanyang University Hospital from Feb. 1972 to Apr. 1986, and the results obtained were as follows. The sex incidence was 26 male(53%) and 23 female(47%) among 49 patients and the ratio between male and female was 1.1: 1. Right hands were involved in 26 patients (53%), left hands were in 15 patients(31%), and both hands were in 8 patients(16%). 2. The most common anomalies among 59 cases in 49 patients were polydactyly (27 cases, 47%) The next anomalies were trigger thumb (25 cases, 44%), syndactyly (3 cases, 5 %), macrodactyly (1 case, 2%), and cleft hand (1 case, 2%) in that orders. 3. The associated congenital anomalies and the maternal histories during pregnancy were not specific. 4. The treatment was stressed upon the functional improvement than the cosmetic one.
Classification ; Clinical Study ; Female ; Hand ; Humans ; Incidence ; Male ; Methods ; Polydactyly ; Pregnancy ; Syndactyly ; Trigger Finger Disorder

BACKGROUNDS: Intestinal obstruction is one of the main causes of neonatal operations. It is caused by congenital factors, inherited diseases, and acquired diseases. A study was made to understand the status of neonatal intestinal obstruction cases at our hospital. METHODS: This was a clinical analysis of 53 cases of neonatal intestinal obstruction which had been experienced from March 1992 to February 1998 at the Department of General surgery, Sung-Ae General Hospital. RESULTS: 1) Operations for neonatal intestinal obstructions accounted for 42.4% of all neonatal operations. 2) There were 38 males and 15 females; the male-to-female ratio was 2.5:1. 3) Gestational period of 9 cases (16.9%) was less than 36 weeks and the weight in 10 cases (18.8%) wre below 2,500 gm at birth. 4) The main clinical symptoms on admission were vomiting or abdominal distension. 5) There were 49 cases (92.4%) of mechanical obstruction and 4 cases of a paralytic ileus. 6) Associated anomalies were present in 9 cases (16.9%). 7) The postoperative complication and motality rates were 30.1% and 7.5% respectively. CONCLUSIONS: Our clinical data might provide clinical suspicisions leading to early diagnosis and treatment.
Early Diagnosis ; Female ; Hospitals, General ; Humans ; Intestinal Obstruction* ; Intestinal Pseudo-Obstruction ; Male ; Parturition ; Postoperative Complications ; Vomiting

ANCA-associated vasculitis is one of the immunologic cause of diffuse alveolar hemorrhage (DAH). We experienced a rare case of recurrent DAH in a 67-year-old man with ANCA-associated vasculitis who had been on maintenance hemodialysis. Two years ago, he presented with renal failure and hemoptysis. Hemoptysis caused by DAH was resolved immediately and hemodialysis was applied because of persistent uremic symptom. On maintenance hemodialysis, three recurrences have happened so far. At present, oral prednisolone and oral cyclophosphamide are being maintained during outpatient follow-up. Our report suggests that the nephrologist must be concerned about the possibility of recurrent aleveolar hemorrhage in ANCA associated renal disease patients and consider immunosuppressive treatment, even though the patient has been on maintenance hemodialysis.
Aged ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis ; Antibodies, Antineutrophil Cytoplasmic ; Cyclophosphamide ; Follow-Up Studies ; Hemoptysis ; Hemorrhage* ; Humans ; Outpatients ; Prednisolone ; Recurrence ; Renal Dialysis ; Renal Insufficiency ; Vasculitis*

BACKGROUND: Acute renal infarction is an uncommon disease which is often delyed or missed due to its rarity and unspecific clinical presentation. METHODS: In order to evaluate the clinical features and to elucidate diagnostic or therapeutic options, we analyzed the medical records of 23 patients who were admitted to Pusan National University Hospital from January, 1995 to July, 2004 and diagnosed as renal infarction. RESULTS: The mean age of the patients was 57.3 18.4 years and male to female ratio was 0.91:1. Underlying diseases were cardiovascular disease (n=18), tumor embolism (n=1), vasculitis (n=1), post kidney transplantation thrombosis (n=1), and trauma(n=1). One patient did not have any underlying disease. Initial symptoms were abdominal or flank pain (61%), fever (35%), anorexia (35%), nausea (26%), vomiting (17%), gross hematuria (9%), and oliguria (4%). On physical examination, costovertebral angle tenderness (43%), abdominal tenderness (9%), and hypertension (35%) were noted. Initial abnormal laboratory findings were elevated serum level of LDH (100%), AST (87%), ALT (83%), CK (22%), and creatinine (>1.4 mg/dL, 17%). Imaging diagnosis of renal infarction included renal angiography, isotope renal scan, computed tomography or ultrasonography. CT was done in 17/23 cases and useful in diagnosis of renal infarction. Nine patients were treated with heparin or warfarin. Thrombolysis was done in 3 patients. Others were treated conservatively. CONCLUSIONS: In a patients with an increased risk of thromboembolism, flank or abdominal pain, microscopic hematuria, and an elevated serum LDH are strongly supportive of diagnosis of renal infarction. Under such circumstances, enhanced CT is essential for the early diagnosis of renal infarction.
Abdominal Pain ; Angiography ; Anorexia ; Busan ; Cardiovascular Diseases ; Creatinine ; Diagnosis ; Early Diagnosis ; Female ; Fever ; Flank Pain ; Hematuria ; Heparin ; Humans ; Hypertension ; Infarction* ; Kidney Transplantation ; Male ; Medical Records ; Nausea ; Neoplastic Cells, Circulating ; Oliguria ; Physical Examination ; Renal Insufficiency ; Thromboembolism ; Thrombosis ; Ultrasonography ; Vasculitis ; Vomiting ; Warfarin

BACKGROUND: The demand for Rh-related and other specific antigen negative donations has increased recently, and in response, we need to improve work efficiency while decreasing reagent consumption. Thus, we desire to create a ‘table of Nambu Blood Laboratory Center's own Rh-related and other antigen negative rate’. METHODS: We analyzed the results of Rh-related specific antigen test for 2,806,330 donors using ‘PK-7300’ and the results of manual test for 10,024 other blood type antigen-related specific and compound antigens. We made a table summarizing the results using two cases. RESULTS: The negative rate of Rh-related specific antigens was approximately 12.9% for C, 41.7% for c, 49.5% for E, and 9.2% for e antigens. The negative rate of compound antigens was increased when compared with the number of inspections. The negative rate for C and e antigens was increased from 90.1% to 97.3%, and that for E, c, and JKa was increased from 7.6% to 31.6%. CONCLUSION: The negative rate table made in July 2016 has been determined to be very effective in screening for specific and compound antigen negative blood. Also it was very efficient in terms of examining and supplying the compound antigen negative blood. It would be helpful to improve the supply of specific antigen negative blood to better meet the unique needs of each medical institution.
Hepatitis B e Antigens ; Humans ; Mass Screening ; Tissue Donors

BACKGROUND: Henoch-Shnlein purpura is a systemic disease and has characteristic features of purpuric skin rash, abdominal pain, arthralgia and abnormal urinary findings and characterized by immunoglobulin A deposits in the involved organ. Renal involvement is the most important prognostic factor in Henoch-Shnlein purpura. METHODS: I retrospectively analyzed the clinical data of 48 patients with Henoch-Shoenlein purpura and 10 biopsy-proven Henoch-Schoenlein nephritis examined at Pusan National University Hospital. RESULTS: 23 cases were males and 25 cases females. Male to female ratio was 1:1.08. The peak of seasonal incidence was seen in spring (41.7%) and winter (27.1%) At presentation, skin purpura was present in 100% of patients, arthralgia was reported in 52.1% and gastrointestinal involvement in 70.8%. 75% of the patients showed renal involvement and pulmonary hemorrhage observed in 2 cases. Common types of skin rash were petechiae, purpura and erythematous maculopapular lesion on the lower extremities. The most common gastrointestinal symptom was abdominal pain (82.3%). Frequently involved joints were knee and ankle (48.0%). Renal involvement were microscopic hematuria (50.0%), proteinuria (50.0%), gross hematuria (29.2%). 25% of patients reached renal insufficiency (GFR<70 mL/min) and 4 cases (8.3%) reached acute renal failure (GFR<30 mL/min and anuria) and 3 patients of them experienced hemodialysis. All renal biopsies showed predominant IgA mesangial deposition. There were 2 cases of grade II, 6 cases of grade III and 2 cases of grade IV by classification of Meadow. Steroids were given in 16 patients (33.3%). Methylprednisolone pulse treatements were given in 4 patients for severe nephritis. 10 patients received angiotensin converting enzyme inhibitor. Clinical remission of extrarenal symptoms was achieved in 83.3% but relapses of purpura were observed in 27.1%. Clinical remissions of nephritis defined as the absence of proteinuria, hematuria and normal renal function was achieved in only 8.3%, Abnormal urinary finding continued in 37.8%. 8.3% of patients expired. CONCLUSION: Although it has been well known that Henoch-Shnlein purpura has benign courses, we experienced 4 case of deaths and The cause of death was acute renal faliure, pulmonary hemorrhage, adult respiratory distress syndrome, massive gastrointestinal bleeding, peritonitis due to bowel perforation.
Abdominal Pain ; Acute Kidney Injury ; Adult* ; Ankle ; Arthralgia ; Biopsy ; Busan ; Cause of Death ; Classification ; Exanthema ; Female ; Hematuria ; Hemorrhage ; Humans ; Immunoglobulin A ; Incidence ; Joints ; Knee ; Lower Extremity ; Male ; Methylprednisolone ; Nephritis ; Peptidyl-Dipeptidase A ; Peritonitis ; Proteinuria ; Purpura ; Purpura, Schoenlein-Henoch* ; Recurrence ; Renal Dialysis ; Renal Insufficiency ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Seasons ; Skin ; Steroids

BACKGROUND: In patients with chronic renal failure, infection is caused by altered host defense mechanism, and contributes significantly to their morbidities and mortalities. Especially, urinary tract infection often occurs in patients with chronic renal failure and is due to azotemia, infrequent voiding, low urinary flow rate and urinary concentration defects. This study was designed to compare the incidence of asymptomatic bacteriuria with chronic renal failure with that of normal control group. We also investigated whether risk factors for urinary tract infections in patients with chronic renal failure are similar to those in normal control groups. METHODS: 34 patients (M : F=13 : 21) with chronic renal failure and 30 normal control groups (M : F= 11 : 19) were evaluated in the Pusan National University Hospital from January 2001 through December 2001. Etiology of chronic renal failure included diabetes mellitus (n=16, 47.1%), hypertension (n=14, 41.2%) and glomerular diseases (n=4, 11.7%). 25 patients were treated with hemodialysis and 5 patients were treated with peritoneal dialysis. Others (n=4) were not treated with dialysis. Clean-catch, first voided urine was collected in the morning and examined by routine urinalysis and urine culture. RESULTS: 7 of 34 (20.6%) patients with chronic renal failure were positive in urine cultures and only one of 30 (3.3%) from the normal control group were positive. E. coli (n=2), Acinetobacter baumanii (n=2), Enterococcus spp. (n=2), S. aureus (n=1), P. aeruginosa (n=1), S. epidermidis (n=1) and Str. viridans (n=1) are cultured from urine specimens. There was a significant difference between the incidence of asymptomatic bacteriuria in patients with chronic renal failure and that of normal control group. But there was no significant difference in the presence of bacteriuria according to sex, age, etiology of renal failure, dialysis modality and pyuria. CONCLUSION: Patients with chronic renal failure have higher frequency of asymptomatic bacteriuria and pyuria than healthy subjects and tend to lead to symptomatic urinary tract infections.
Acinetobacter ; Azotemia ; Bacteriuria* ; Busan ; Diabetes Mellitus ; Dialysis ; Enterococcus ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic* ; Mortality ; Peritoneal Dialysis ; Pyuria ; Renal Dialysis ; Renal Insufficiency ; Risk Factors ; Urinalysis ; Urinary Tract Infections

BACKGROUND: Chronic kidney disease has deleterious influences on pregnancy, both fetus and mother. To determine the pregnancy outcome and associated risk factors, we analyzed 36 pregnancies in 26 women with various chronic kidney diseases. METHODS: Retrospective analysis of 36 pregnancies was performed in women with chronic kidney disease who underwent antenatal care and delivery at Pusan National University Hospital from January 1993 to December 2002. RESULTS: The mean age of patients was 29.7 +/- 3.6 years. Underlying kidney disease was lupus nephritis in 10 patients (11 pregnancies), IgA nephropathy in 7 patients (8 pregnancies), focal segmental glomerulosclerosis in 4 patients (9 pregnancies), membranoproliferative glomerulonephritis in 4 patients (7 pregnancies), membranous glomerulonephritis in 1 patient (1 pregnancy). Of the 36 pregnancies, fetal loss occurred in 14 pregnancies (38.9%), premature delivery 7 pregnancies (19.4%) and normal delivery 15 pregnancies (41.7%). Deterioration of maternal renal function occurred in 10 pregnancies (27.8%), hypertension 18 pregnancies (50.0%) and aggravation of proteinuria 26 pregnancies (72.2%). Fetal loss and deterioration of maternal renal function were more frequent in patients with preconception serum creatinine value (SCr) >or=1.4 mg/dL than in those with SCr <1.4 mg/dL (85.7% vs. 27.6%, p<0.05; 100% vs. 10.3%, p<0.05, respectively). Neither fetal loss nor deterioration of maternal renal function was associated with hypertension and aggravation of proteinuria. In multivariate analysis, preconception SCr was associated with fetal loss (p=0.014, OR 32.7, 95% CI 2.0-526.0) and BP >or=140/90 mmHg during pregnancy was associated with low birth weight (p=0.027, OR 0.034, 95% CI 0.002-0.682). Deterioration of maternal renal function during pregnancy was recovered in 40.0%, hypertension was recovered in 50.0% and proteinuria was recovered in 77.8% within 1 year after delivery. CONCLUSION: Preconceptional impairment of maternal renal function and uncontrolled hypertension during pregnancy seem to be an important factors associated with fetal loss and low birth weight, respectively.
Busan ; Creatinine ; Female ; Fetus ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Humans ; Hypertension ; Infant, Low Birth Weight ; Infant, Newborn ; Kidney Diseases ; Lupus Nephritis ; Mothers ; Multivariate Analysis ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Proteinuria ; Renal Insufficiency, Chronic* ; Retrospective Studies ; Risk Factors

PURPOSE: This study was conducted to explore the process and operation of a cancer multidisciplinary team (MDT) after the reimbursement decision in Korea, and to identify ways to overcome the major barriers to effective and sustainable MDTs. MATERIALS AND METHODS: Approximately 1,000 cancer specialists, including medical oncologists, surgical oncologists, radiation oncologists, pathologists, and radiologists in general hospitals in Koreawere invited to complete the survey. The questionnaire covered the following topics: organizational structure of MDTs, candidates for consulting, the clinical decision-making initiative, and responsibility for dealing with legal disputes. RESULTS: We collected a total of 179 responses (18%) from physicians at institutions where an MDT approach was active. A surgical oncologist (91%), internist (90%),radiologist (89%),radiation oncologist (86%), pathologist (71%), and trainees (20%) regularly participated in MDT operations. Approximately 55% of respondents stated that MDTs met regularly. In cases of a split opinion, the physician in charge (69%) or chairperson (17%) made the final decision, and most (86%) stated they followed the final decision. About 15% and 32% of respondents were “very satisfied” and “satisfied,” respectively, with the current MDT's operations. Among 38 institutional representatives, 34% responded that the MDT operation became more active and 18% stated an MDT was newly implemented after the reimbursement decision. CONCLUSION: The reimbursement decision invigorated MDT operations in almost half of eligible hospitals. Dissatisfaction regarding current MDTs was over 50%, and the high discordance rates regarding risk sharing suggest that it is necessary to revise the current system of MDTs.
Clinical Decision-Making ; Dissent and Disputes ; Hospitals, General ; Korea* ; Specialization ; Surveys and Questionnaires