The depth of wound level is as important as the level of the tendon injury itself. And the timing of the operative procedure is an important factor. As a rule, tendons injured outside of the flexor sheath yield much better results than those injured within the sheath. The nutritional supply of the flexor tendons is not completely understood. Many elaborate studies have outilned the vascular anatomy of these tendons, and not all authors are in agreement. It is now clear that synovial fluid within the sheath supplies nutrition to the tendon much as synovial fluid in a joint supports cartilage. With this in mind, the present study was designed to determine the effect of exposing tendons for varying periods of time on the viability of the tendon and sequential morphological changes. The results are as follows: 1. Twelve hours after tendon sheath removal, collagen fibrillar dissociation and irregular surface of the tendon sheath were noted on the chicken flexor tendons by electronmicroscopy. 2. Superficial tenocyte necrosis was created after 24 hours of tendon exposure. 3. At 3 days, inflammatory cell infiltration and thickening of the outer synovial layer were noted. After 7 days, fibrosis of the degenerated tendon started from the exposed surface. 4. The fibrous connective tissue and new blood vessel infiltration into the tendon were progressed after 7 days. From these morphological results, any interference with the synovial environment leads to a regressive change of the flexor tendons immediately. It is suggested that delayed primary wound covering procedure within three days an after exposed tendon injury is ideal, and it should by done at least 7 days after tendon exposure.
Blood Vessels ; Cartilage ; Chickens ; Collagen ; Connective Tissue ; Equipment and Supplies ; Fibrosis ; Joints ; Necrosis ; Surgical Procedures, Operative ; Synovial Fluid ; Tendon Injuries ; Tendons ; Wounds and Injuries

'Marjolin' ulcer' is used to describe the malignant transformation of a chronic ulcer which has developed in a burn scar. Clinically, although the lesions is slowly progressive, it comes to be more aggressive when the scar barrier is disrupted. We reviewed 24 cases in patients who complained of chronic burn wounds suspected to be Marjolin's ulcer. The mean latent period for developing pathologic lesions was 31 years. Histologically, chronic ulcer and pseudoepitheliomatous hyperplasia were 21% respectively, while malignancy including squamous cell carcinoma and leiomyosarcoma was 56%. The mean elapsed time to diagnose squamous cell carcinogma was 33.2 years. In pseudoepitheliomatous hyperplasia which is considered as a transitional state to malignant tumor, wide excision and reconstruction with free muscle flap was a better procedure than skin graft for the prevention of recurrence and malignant transformation. As well, the same modality of treatment was also applied in malignant tumors.
Burns* ; Carcinoma, Squamous Cell ; Cicatrix ; Humans ; Hyperplasia ; Leiomyosarcoma ; Recurrence ; Skin ; Transplants ; Ulcer ; Wounds and Injuries*

This study includes 40 patients of post-traumatic facial bone deformities to whom underwent realignment of zygomatic bone. In 13 cases, we modified the approach technique using limited exposure such as subciliary, intraoral and preauricular incisions instead of conventional wide exposure. Preoperative evaluation of deformity was done by using x-rays, photographs and detail communication with the patients. Through this limited exposure, osteotomy and repositioning of the zygoma were accomplished. There were no postoperative differences between wide and limited exposure, but limited exposure was more advantageous in terms of reduced operative time, transfusion, hospitalization and scaring. This approach was an effective method for the relatively simple tetrapod type-malunited fracture of zygoma without comminution.
Congenital Abnormalities ; Facial Bones ; Hospitalization ; Humans ; Operative Time ; Osteotomy ; Zygoma*

The funding acknowledgment in this article was omitted.

No abstract available.

Hyperkeratosis of the nipple and areola is a rare skin disordr characterized clinically by thickening and discoloration of the skin of the areola and/or nipple and pathoiog cally by papillomaosis or acanthosis-nigricans like changes. We report a case of hyperkeratosis of the nipple and areola occuring in a woman with no underlying endocrinopathy and no other additional hyperkeratotic conditions. Ttie iresent case seems to be the nevoid form by the Levy-Franckel classification. Treatment with topical medications including steroids and keratolytic agents produced no improvement. Therefore we recommeneded surgical excision because the paient was greatly disturbed by the appearance of the lesions. Surgical excision and full thickness skin graft were performed sucessfully.
Classification ; Female ; Humans ; Keratolytic Agents ; Nipples* ; Skin* ; Steroids ; Transplants*

Distal radioulnar is a part which has a rotational movement through the function of distal radioulnar joint and extensor carpi ulnaris. The injury mechanism in this area is usually a trauma largely due to traffic accidents. In general these injuries to the distal radioulnar joint are treated by a closed reduction. However, the isolated distal ulnar fracture without radial fracture, which is often called the night stick fracture, is difficult to treat by a closed reduction and a cast immobilization alone, especially if there is a displacement or fracture segment impinging soft tissue or severe comminution. Nonunion has been the frequent outcome with this method of treatment and limitation of rotation of forearm and distal radioulnar joint have occurred due to long period of immobilization or malunion. Thus, a different treatment modality such as open reduction and internal fixation and early active joint motion has arisen as a better treatment modality. In this study, 8 cases of isolated distal ulnar fracture without radial fracture have recieved the operation and the early active joint movement, if a displacement was present either at the time of injury or after the initial closed reduction. As a result, this method has enabled the patients to reduce the rate of complication of nonunion and to recover limitation of joint motion in a shorter time period.
Accidents, Traffic ; Forearm ; Humans ; Immobilization ; Joints

No abstract available.

PURPOSE: The purpose of this study is to survey health requirements of middle-aged women and their families and to provide guidelines for developing nursing interventions by describing the process of family health maintenance experienced by middle-aged women and its conceptual system. METHODS: To get saturated data, each of four researchers conducted two or three times of in-depth interview with eight middle-aged women aged between 40-64 years old and living in Seoul and Chuncheon from the 10th to the 30th of October 2004 and each interview was continued one or two hours. The Grounded theory adopted by Strauss & Corbin (1998) is a substantive theory that can explain the experiencing process of middle-aged women. RESULTS: We found that the casual condition of family health maintaining by middle-aged women was "confidence of health belief", and "pouring by body moving" was found to be its phenomenon. A textual condition that might respond to the phenomenon was "fatal roles acceptance", and intervening conditions that promote their family health were "retracing" and "gathering health information". These intervening conditions impacted middle-aged women's confidence in family health and led them to take actions/interactions such as "being a model of health", "adapting to circumstances", "do-it-myself", "taking-care" "harmonious mind" and "the pursuit of cleanness". These actions/interactions produced results such as "being stronger", "being unmanageable" and "being fruitful". CONCLUSIONS: Health confidence and practical health behaviors were observed in the process that the middle-aged female participants experienced unmanageable circumstances but they accepted their roles and responsibilities and recognized that they must be get stronger. The behaviors of health-together-with were divided into enthusiastic type, adaptation type and self-sacrificing type. Therefore middle-aged woman with the understanding of family health maintaining process as well as the theoretical system and practical principals needs to implement the intervention in acceptable level of family health process of preventing psychological and physical problems.
Family Health* ; Female ; Gangwon-do ; Health Behavior ; Humans ; Nursing ; Seoul

NMP is a kind of protein relating to the internal structural framework of the nucleus, which is related to gene expression and regulation such as DNA replication and processing of RNA, and is made in tumor cell more than in normal cell. The object of this study is to evaluate the utility of NMP22 in urine as the possible marker of monitoring the transitional cell carcinoma of the bladder. Two groups attended the trial of NMP22; 1) 25 healthy volunteers 2) 25 patients with the transitional cell carcinoma of the bladder. The result is that the values of the mean NMP22 of the healthy volunteers and the patients with the transitional cell carcinoma of the bladder were 4.04+/-1.83 U/ml and 186.9+/-405.9 U/ml, respectively. The difference was statistically significant (p=0.028). The value of urinary mean NMP22 according to the tumor grade and the tumor stage didn`t show the significant difference statistically (grade I: 41.3+/-51.9 U/ml, grade II: 167.6+/-369.3 U/ml, grade HI: 362.7+/-605.5 U/ml, superficial TCC: 204.2+/-453.0 U/ml, invasive TCC:132.0+/-217.1 U/ml). In detecting the transitional cell carcinoma of the bladder, the sensitivity of urine cytology was 68% and the sensitivity of combining urinary NMP22 and urine cytology was 88%, when the value of the urinary NMP22 over 7.70 U/ml was considered as the positive. Urinary NMP22 is expected to increase the diagnosis and the detection of recurrence of the transitional cell carcinoma of the bladder if it is used together with the urine cytology as the urinary tumor marker of the transitional cell carcinoma of the bladder.
Carcinoma, Transitional Cell* ; Diagnosis ; DNA Replication ; Gene Expression ; Healthy Volunteers ; Humans ; Nuclear Matrix* ; Recurrence ; RNA ; Urinary Bladder Neoplasms ; Urinary Bladder*