Chronic cavities of the dorsum of the foot often have bare bone and are unsuitable for free skin grafting. Local Flaps are often impossible because of surrounding scar tissue and dead space. A simple method is presented; it consists of the excision of the lesion, filling the cavity by a two staged random-pattern de-epithelialised turn over flap, and skin graft.
Cicatrix ; Foot ; Methods ; Skin ; Skin Transplantation ; Transplants

Twenty one patients with multiple, large or recurrent superficial bladder cancer were treated with intravesical Mitomycin C instillation after TUR, and another 22 patients were treated with TUR alone The Mitomycin C group and control group were statistically identical in tumor size, grade, multiplicity and recurrences. Mean follow-up period were 13.9 months in Mitomycin C group and 23.2 months in controls. Recurrence rate was 42.9% in Mitomycin C group, and 40.9% in controls during the first 3 months and it was 66.7% and 68.2% respectively during the 12 months. Recurrences per 100 patient months was lO.1 and 9.6 respectively and the interval between the treatment and the first recurrence was 6.69 and 7.28 months respectively. Two of 21 patients in Mitomycin C group and 4 of 22 patients in controls had recurrent tumors with progression in stage during the follow-up period. There was no significant difference between the 2 groups. Therefore we can conclude that intravesical Mitomycin C instillation is not effective in the prophylaxis of tumor recurrence in the special group of patients with high risk of recurrence. This result is contrary to the several reports indicating marked reduction of recurrence by Mitomycin C. We discussed some factors which might influence to the 2 different outcome.
Follow-Up Studies ; Humans ; Mitomycin* ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. This study was carried out to identify diseases and health service utilization patterns of geriatric inpatients to provide better understanding and basis planning to meet the needs of expanding geriatric population. METHOD: We use data of `Patient Survey in Korea` in 1999 and analyzed characteristics of disease structure and utilization patterns of health care service of 54,013 cases of discharged patients aged 65 years or more. RESULT: The proportion of the elderly in total discharged patients is 14.7%. Male to female ratio is 1:1.3 and most common age group was between 65 and 69 years old. 84.2% of elderly patients were admitted at secondary or tertiary health care facilities. The most common disease in geriatric inpatients is malig- nancy in male and vascular disease in female. The average duration of hospitalization is 14.2 days. They stay longer than the nation wide average hospital length and stay longest when they are admitted by mental and behavioral disorders. CONCLUSION: Geriatric patients are admitted mostly with chronic degenerative diseases such as neoplasm and vascular disease. Elders prefer to be admitted to tertiary hospitals and oriental hospitals. They stay more in hospital.
Aged ; Delivery of Health Care ; Female ; Health Services* ; Hospitalization ; Humans ; Inpatients* ; Korea ; Male ; Tertiary Care Centers ; Vascular Diseases

BACKGROUND: The purpose of our study was to evaluate the functional and radiologic outcomes of additive augmentation sutures through rotator cuff for proximal humeral fractures stabilized locking plate in elderly patients. METHODS: We enrolled 74 patients over the age of 60 years who received internal fixation using locking plates for proximal humeral fractures. Of these, 50 patients had additive augmentation sutures through rotator cuff. The mean age at the time of surgery was 72.1 years (range, 60-89 years), and the mean follow-up period was 17.5 months (range, 12-62 months). The humeral neck-shaft angle and humeral head height were used as radiological markers to assess the effect of additive augmentation sutures through rotator cuff. We allocated the patients who received additive augmentation sutures into group A and those who did not into group B. RESULTS: At the final follow-up, the mean Korean Showlder Society score and Constant scores were 88.96 +/- 12.1 and 86.6 +/- 11.9, respectively, in group A and 86.21 +/- 11.8 and 85.3 +/- 11.7, respectively, in group B (p=0.368, 0.271). At the final follow-up, the mean loss in humeral neck-shaft angle from the time of immediate postoperative measurement was 1.6degrees in group A and 4.8degrees in group B, whereas the mean loss in humeral head height was 0.82 mm in group A and 0.52 mm in group B (p=0.029, 0.178). CONCLUSIONS: The surgical outcomes of internal fixation using locking plates for proximal humeral fractures were clinically and radiologically good in elderly patients over the age of 60 years without any observable complications. Further, the loss of humeral head shaft angle at the final follow-up from its initial postoperative measurement was significantly smaller in patients who received an additive augmentation suture than in those who did not. Thus, we conclude that augmentation sutures are a beneficial option for elderly patients that clinicians can consider at the time of surgical decision making.
Aged* ; Decision Making ; Follow-Up Studies ; Humans ; Humeral Head ; Rotator Cuff ; Shoulder Fractures* ; Sutures*

Spondylometaphyseal dysplasia (SMD) is an extremely rare, which affects the spine and metaphy-ses of the tubular bones on terms of enchondrogenesis. Children who had Kozlowski dwarfism, type of SMD are not recognized until they reach school age since they have normal clinical feature, weight and size in early childhood. Authors experienced a typical case of Kozlowski type of SMD in a 10 years old male who had i) generalized platyspondyly with anterior tapering of vertebrae ii) generalized metaphyseal dysplasia iii) minimal changes in the carpal and tarsal bones. This case is to be reported with review of references.
Child ; Dwarfism ; Humans ; Male ; Spine ; Tarsal Bones

PURPOSE: To evaluate the characteristic MR findings in injury of the anterior cruciate ligament (ACL) with associated bony lesions. MATERIALS AND METHODS: We reviewed MR findings and the corresponding arthroscopic or operative results of 48 patients with ACL injuries, and evaluated ACL signal intensity and contour. In associated bony lesions, we determined the location of avulsion fracture and bony bruise. RESULTS: Cmplete ACL tears were seen in 27 cases, partial tears in 13, and avulsion injury in eight. Complete tears showed heterogeneously increased signal intensity with contour bulging in ten cases (37 %), and combined bony lesion in 14 (52 %). ACL with a thin continous low signal intensity band surrounding heterogeneously-increased signal intensity suggested partial tears, and was seen in three of 13 proven cases (23 %) of partial ACL tears ; combined bony lesion was seen in four such cases (31 %). There were eight cases of avulsion fracture ; the most frequent site was the anterolateral portion of the tibial spine (n=6). The most frequent sites of bony lesion were at the midportion of the lateral femoral condyle (n=6), and the posterior portion of the lateral tibial plateau (n=6) ; the next most frequent site was the anterior portion of the lateral tibial plateau (n=5). CONCLUSION: Tearing of the ACL was seen on MRI as ligament discontinuity, and heterogeneously increased signal intensity with ACL contour bulging. The most frequent sites of associated bony lesions were the midportion of the lateral femoral condyle, and the posterior portion of the lateral tibial plateau. In associated bony lesions, bony contusion suggested ACL tearing, but avulsion fracture suggested ligament avulsion injury without tear.
Anterior Cruciate Ligament* ; Contusions ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Spine

To evaluate the long-term effect and complications of the transurethral resection of the prostate (TUR-P), we analyzed its results of 404 patients who were followed properly out of 827 patients who underwent TUR-P at Seoul National University Hospital from January 1980 to December 1993. Various pre-existing medical problems were associated in 173 patients(42.8%). The mean weight of the resected tissue was 15.6 grams and the mean operation time was 78.9 minutes with the resection amount per minute of 0.2 gm/min. Improvement of the symptoms was reported in 304 patients(75.2%) postoperatively. International prostate symptom score(IPSS) was 22.6 preoperatively, 15.4 at 3 months, 9.8 at one year and 9.3 at 3 years after TUR-P: Maximum urinary flow rate(MFR) was 9.7 ml/sec preoperatively, 15.5 at 3 months and 15.9 at one year after TUR- P The perioperative mortality rate was 0.4%, and the perioperative complications occurred in 120 patients(29.7%); including 15.8% of bleeding and 2.2% of the transurethral resection syndrome. The morbidity increased significantly with the increasing resection amount and the operation time. But not only age but also pre-existing cardiopulmonary diseases and azotemia did not influence the morbidity. Only age over 80 and preoperative urinary tract infection increased the perioperative morbidity slightly. Late complication developed in 54 patients(13.4%); urinary tract infection in 18 (4.5%), urethral stricture in 16 (4.0%), impotence in 9 (2.2%), urinary in- continence in 5 (1.2%), bladder neck contracture in 4 (1.0%) and bleeding in 2 (0.5%). Persistent voiding difficulties were reported in 100 patients(25.7%), causes were neurogenic bladder in 32, inappropriate indication of TUR-P in 32, and incomplete resection in 18 patients and so on. Repeated TUR-P was done in 16(4.0%) patients.
Azotemia ; Contracture ; Erectile Dysfunction ; Follow-Up Studies* ; Hemorrhage ; Humans ; Male ; Mortality ; Neck ; Prostate ; Prostatic Hyperplasia* ; Seoul ; Urethral Stricture ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Tract Infections

Malignancy may cause variable musculoskeletal symptoms which resemble connective tissue disorder. This symptoms as a fine sign of hidden neoplasm can precede the diagnosis of underlying malignancy. But only one case of stomach cancer associated with cancer arthritis was reported in the world. This fact is very interesting in Asia which has high prevalence of stomach cancer. We experienced one case of gastric adenocarcinoma with oligoarthritis involving both knee and right elbow. A 48-year-old man was diagnosed stomach cancer by gastric endoscope and biopsy. After then, he complained pain, tenderness, heating sensation, swelling of both knee and right elbow with high fever. Both knee MRI showed abundant synovial effusion and soft tissue edema. Full dose of nonsteroidal anti-inflammatory drug was not effective to control fever and arthritis. But fever and arthritis were gone after resection of tumor.
Adenocarcinoma* ; Arthritis ; Asia ; Biopsy ; Connective Tissue ; Diagnosis ; Edema ; Elbow ; Endoscopes ; Fever ; Heating ; Hot Temperature ; Humans ; Knee ; Magnetic Resonance Imaging ; Middle Aged ; Prevalence ; Sensation ; Stomach Neoplasms

A study was done to evaluate whether intraperitoneal Polyinosinic: Polycytidylic acid (Poly I:C) administration in addition to BCG could enhance the anticancer effect of BCG on subcutaneously implanted syngeneic murine bladder tumor. The appropriate administration schedules of Poly I:C and BCG were defined by evaluating the change of natural killer cell activity and cell mediated cytotoxic effect against syngeneic bladder tumor cells or splenic and peritoneal lymphocyte at regular time interval. The prophylactic anticancer effect of Poly I:C alone and Poly I:C plus BCG were evaluated by observing the tumor take rate and growth change of the taken tumor compared to the control group. Bladder tumor take rate and growth of the taken tumor were suppressed after administration of Poly I:C alone. Natural killer cell activity of the splenic and peritoneal lymphocytes were enhanced and in vitro cytotoxicity against MBT-2 was increased after Poly I:C administration. When Poly I:C was administrated in addition to BCG, tumor take rate and tumor growth were more suppressed and the time for appearance of the visible tumor was prolonged compared to BCG therapy alone. In conclusion, Poly I:C showed prophylactic anticancer effect against subcutaneously implanted murine bladder tumor when used alone or in combination with BCG, and the cell mediated cytotoxicity including enhanced NK cell activity seemed to play an important role in their anticancer effect. These results suggest a possibility of Poly I:C, alone or in combination with BCG, would become a new prophylactic treatment modality against bladder tumors.
Appointments and Schedules ; Killer Cells, Natural ; Lymphocytes ; Mycobacterium bovis* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

We evaluated the relationship between content of epidermal growth factor receptor (EGFR) and responsiveness to epidermal growth factor (EGF) in human renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) cell lines. EGFR was measured by radioisotope ligand binding assay using I-EGF. Three renal cell carcinoma cell lines (Caki-1. Caki-2, A-498) and 4 transitional cell carcinoma cell lines (T-24. J-82. HT-1197. HT-1376) were used. Growth of cell lines was tested in serum free RPMI 1640 media with or without various concentration of EGF by MTT assay. The content of EGFR was far higher in HT-1197than the other cell lines. EGFR contents were higher in RCC than in TCC cell lines except HT-1197. All RCC and TCC cell lines did not grow in serum free RPMI 1640 media. In EGF supplemented condition, HT-1197 and 3 RCC cell lines which showed high content of EGFR were stimulated to grow in a dose related fashion, but T-24. J-82 and HT-1376 cell lines which showed low content of EGFR were not. Growth rates of RCC and TCC cell lines were closely related with the content of EGFR under influence of EGF.
Carcinoma, Renal Cell* ; Carcinoma, Transitional Cell* ; Cell Line* ; Epidermal Growth Factor* ; Humans* ; Receptor, Epidermal Growth Factor