Skin defects unable to close by primary intention have caused many difficulties. Complex surgical interventions such as repetitive debridements, skin graft, or flap have been performed as therapeutic methods. Recently, new techniques for the skin closure based on the stretching property, elasticity or stress relaxation, have been introduced. This biomechanical property exhibits that the force required to keep the skin at a stretched length decreases over time. As the skin is stretching, the convoluted collagen fibers in dermis are straighten and become a line in the direction of stretching force. Fifteen cases of skin defects associated with fracture were closed by a new dynamic closing method at Department of Orthopaedic Surgery, Yonsei University College of Medicine. Two spinal needles were inserted into dermis along the wound margins on each side in order to distribute the even tension. The wound margins were approximated by suture wires engaged with the needles. We have experienced successful results using new stretch closing method in fracture with skin defect. It is confirmed that this method is rapid, simple, cost-effective, cosmetic, and safe way to close the skin defect and shortens hospital stay.
Collagen ; Debridement ; Dermis ; Elasticity ; Fractures, Open ; Intention ; Length of Stay ; Methods ; Needles ; Relaxation ; Skin ; Sutures ; Transplants ; Wounds and Injuries

The authors analyzed 11 patients of hypertensive intracerebral hematoma who had undergone the delayed CT guided stereotaxic evacuation. this delayed stereotaxic evacuation seemed to be highly effective in improving the motor weakness rather than mental state. Such effect was appeared immediately after the procedures in most of the patients, even in very small amount of hematoma. In addition, we could shorten the total hospital periods. The most effective time of this delayed stereotaxic evacuation was seemed to be in around 2 weeks after the hemorrhage.
Hematoma* ; Hemorrhage ; Humans ; Hypertension

Osteochondroma is the most common benign bone tumor which commonly occurs in the metaphysis of the long bones such as proximal humerus, tibia, and distal femur. It is rarely found in bones of the foot. Although they are benign lesions, when they occur in the foot, they are typically identified earlier than other regions because of the low proliferation of subcutaneous tissue in the region and may cause symptoms. We experienced a rare case of osteochondroma in a 60-year-old male which cause pain and swelling of the fourth toe.
Femur ; Foot ; Humans ; Humerus ; Male ; Middle Aged ; Osteochondroma ; Subcutaneous Tissue ; Tibia ; Toes

Between December 1979 and September 1989, 23 patients with craniopharyngioma who underwent surgery and postoperative radiation therapy were retrospectively evaluated to assess the efficacy of this management at the Department of Therapeutic Radiology, Seoul National University Hospital. Total removal of tumor was attempted in all patients. Of these, surgeons tried total removal in eight patients, but revealed residual mass by postoperative CT, and partial removal was done in 15 patients. The morphology of tumor on the operative finding was grouped into three types : cystic 13 (57%), solid 4 (17%), and mixed 6 (26%). Cystic type was predominant in< or =20 years old group. Actuarial overall survival rates at 5 and 10 years were 95% and 81% respectively and actuarial tumor control rates were 74% and 50%. Surgical extent was not related to the survival rates(p=0.41). Pediatric and adolescent Patients(age of< or =20 year) had a trend of better survival than that of adult patients(p=0.10). The results indicated that limited surgical excision followed by radiation therapy is recommended when total excision is not possible.
Adolescent ; Adult ; Craniopharyngioma* ; Humans ; Radiation Oncology ; Retrospective Studies ; Seoul ; Survival Rate

Guanine nucleotide exchange factors (GEFs) play multiple functional roles in neurons. In a previous study, we reported that Arhgef4 (Rho guanine nucleotide exchange factor 4) functioned as a negative regulator of the excitatory synaptic function by sequestering postsynaptic density protein 95 (PSD-95). However, the role ofArhgef4 in behavior has not been examined. We performed comprehensive behavioral tests in knockout (KO) mice to investigate of the effects of Arhgef4 deficiency. We found that the expressed PSD-95 particle size was significantly increased in hippocampal neuronal cultures from Arhgef4 KO mice, which is consistent with the previous in vitro findings.Arhgef4 KO mice exhibited general motor activity and anxiety-like behavior comparable to those of the wild type littermates. However, spatial memory and object recognition memory were significantly enhanced in the Arhgef4 KO mice. Taken together, these data confirm the role of Arhgef4 as a negative synaptic regulator at the behavioral level.

Impaction of an ingested foreign body in the colon is uncommon but surgical or endoscopic intervention is occasionally needed when serious complications such as perforation, obstruction or hemorrhage occur. Several factors may predispose a patient to ingestion and subsequent impaction of lower intestinal foreign body. It is more common in the elderly who wear dentures, in the mentally infirm, in chronic alcoholics or rapid eating. The majority of impaction occurs at narrowing and angulation such as ileocecal valve or rectosigmoid junction. The diagnosis of lower intestinal foreign body should be considered, among more common conditions, in the differential diagnosis of elderly patients who present with altered bowel habits. We report the case with a literature review that successfully endoscopically removed the fish bones impacted in the rectosigmoid colon complicated by rectal bleeding.
Aged ; Alcoholics ; Colon* ; Dentures ; Diagnosis ; Diagnosis, Differential ; Eating ; Foreign Bodies ; Hemorrhage ; Humans ; Ileocecal Valve

The prevalence of intestinal tuberculosis has been markedly decreased with the development of antituberculous chemotherapy, improved economic conditions, preventive medicine and early detection and treatment of pulmonary tuberculosis. An even more impressive resurgence of pulmonary and extrapulmonary tuberculosis has been seen in recent years among persons infected with the human immunodeficiency virus. The most common site of intestinal tuberculosis is the ileocecal region, and duodenum is a rare site. Symptoms and signs of duodenal tuberculosis are nonspecific. The gross pathologic appearance of the duodenal tuberculous lesions has to its traditional categorization into three forms: 1) ulcerative, 2) hypertrophic, and 3) ulcerohypertrophic (mixed). Hypertrophic lesions of the duodenal tuberculosis should be differentiated from duodenal adenocarcinoma and lymphoma. We herein report a case of duodenal tuberculosis presenting as intraluminal protruding mass in gastroduodenoscopy and multiple intraabdominal lymphadenopathy on abdominal CT. We have confirmed the duodenal tuberculosis by endoscopic biopsy, and review the current literatures.
Adenocarcinoma ; Biopsy ; Drug Therapy ; Duodenal Neoplasms* ; Duodenum ; HIV ; Humans ; Lymphatic Diseases ; Lymphoma ; Prevalence ; Preventive Medicine ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

Cardiac involvement in systemic lupus erythematosus(SLE) is common and has been reported in more than 50% of the patients at the same stage during their illness. SLE can affect the heart in a number of ways;myocarditis, pericarditis, aortic insufficiency, hypertensive heart disease, and coronary arteritis. In recent years, with prolonged survival and improvement in diagnostic modalities, the cardiovascular manifestations of SLE have become more apparent. Coronary artery disease has a number of possible pathogenic mechanisms;atherosclerosis, coronary arteritis, spasm, and hypercoagulability. For management purposes, differentiation between arteritis and artheroslerosis is important. Atherosclerosis in the coronary as well as other vessels appears to be accelerated by SLE. Cardiovascular care to the SLE patients should be emphasized, because corticosteroid treatment and auto-immune mechanisms of SLE are able to promote the atherosclerosis of coronary arteries. We report 36-year-old otherwise healthy female with SLE who presented with severe ischemic heart disease requiring coronary by-pass surgery.
Adult ; Arteritis ; Atherosclerosis ; Coronary Artery Disease* ; Coronary Vessels ; Female ; Heart ; Heart Diseases ; Humans ; Lupus Erythematosus, Systemic* ; Myocardial Ischemia ; Pericarditis ; Spasm ; Thrombophilia

INTRODUCTION: The aim of the present study was to investigate the effect of mechanical irrigation in combination with mouthwash of antimicrobial agents on salivary bacterial counts. MATERIALS AND METHODS: This study was performed with a randomized study employing a panel of 40 healthy volunteers (20 males and 20 females) between the age of 26 and 32 years. Volunteers were randomly put in one of four treatment groups. In the first group, 0.2 mL of non-stimulatory saliva was collected from every subjective person. Then, saliva was collected after rinsing with chlorhexidine (CHX) for 1 minute. In the second group, non-stimulatory saliva was collected, and then saliva was collected after rinsing with CHX and irrigation with saline. In the third and fourth groups, the same procedures as the first and second groups were performed with povidone iodine (PVI) instead of CHX. All of these samples were cultured for 48 hours aerobically. The reduction rates of colony-forming units (CFU) were calculated for each group. The reduction rate between each group was tested statistically using student t-test. RESULTS: Using CHX in combination with saline irrigation showed a significant decrease of the salivary bacterial CFU when compared with only using CHX.(P<0.01) And using PVI with saline irrigation showed a little decrease of the CFU when compared with only using PVI, but there was no statistical significance.(P>0.01) CONCLUSION: It was concluded that the CHX or PVI used with saline irrigation made the salivary bacterial counts reduced more than when CHX or PVI was used alone as an oral antiseptic agent.
Anti-Infective Agents ; Bacterial Load ; Chlorhexidine ; Humans ; Male ; Mouthwashes ; Povidone-Iodine ; Saliva ; Stem Cells

Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients. Although impaired tissue oxygenation is usually responsible for the rise in lactate production, lactic acidosis could be caused by drugs including metformin and the nucleoside reverse-transcriptase inhibitors. Linezolid, an oxazolidinone antibiotic, is currently indicated to treat serious infections caused by vancomycin-resistant enterococcus and other gram-positive organisms. A 74-year old woman was found to have pyogenic vertebral osteomyelitis and treated with linezolid. Thirty-one days after linezolid therapy, she developed severe lactic acidosis. We report a case of lactic acidosis associated with prolonged linezolid therapy.
Acetamides ; Acidosis ; Acidosis, Lactic ; Enterococcus ; Female ; Humans ; Lactic Acid ; Metformin ; Osteomyelitis ; Oxazolidinones ; Oxygen ; Linezolid