Island flaps have been widely used for the management of soft tissue defects in reconstructive surgery. The necrosis of the flap has been a catastrophe in clinical fields. It is well known that revascularization to the flap after ligation of its pedicle comes from the recipient bed and flap margins. The authors investigated the effects of the ischemic recipient bed on island flap survival after the ligation of its pedicle in the rats. One hundred and thirty inferior epigastric island flaps were divided into three groups (Group I, Group II, and Group III) according to the degree (0%,20%, and 60%) of interruption of contact of flap with the recipient bed, respectively. In Group I,the vascular pedicles were ligated before and on the 0, 2nd, 3rd, 4th and 5th days after flap elevation, and in Group II & III, the vascular pedicles were ligated on the 2nd, 3rd, 4th and 5th days after flap elevation. Flap survival was assessed on the 3rd day after pedicle ligation. Microangiographic studies were also performed on the 3rd day after pedicle ligation to study revascularization within the flap and the change of blood vessels around the flap margins. The results were as follows: 1. Flap survival was increased significantly in the flaps with pedicle ligation on the 4th and 5th postoperative days compared to those at the 2nd and 3rd postoperative days. 2. From the 3rd postoperative day, flap survival was not influenced significantly by the degree of limited bed contact and the date of pedicle ligation. 3. In spite of limited bed contact, the flap will likely survive with abundant revascularization from the flap margins. In conclusion, the flaps with limited bed contact were revascularized significantly from the flap margin by the 3rd postoperative day.
Animals ; Blood Vessels ; Ligation ; Necrosis ; Rats ; Surgical Flaps

Massive ovarian deema is a tate conditian. It is a benign enlargement of the ovary caused by accumulation of fluid, which is thought to result from intermittent partial toraion of the ovarian pedicle. Histologically, the ovaries were characterized by diffuse edema of medulla and inner cortex. Two cases of massive ovanan edema are reported with brief review of the literatures.
Edema* ; Female ; Ovary

PURPOSE: The purpose of this study was to analyze the flow signal chracteristics of 3 dimensional time of flight MR angiography (3D TOF MRA) by using a flow phantom model. MATERIALS AND METHODS: Nonpulsatile flow phantom and tap water were used in this experiment. We performed FISP 3D TOF MRA with various values of parameters (repetition time ; 34-100 msec, flip angle ; 10degrees-50degrees, flow velocity ; 14.7-73.6 cm/sec, Gd-DTPA concentration ; 0.6-3.6 mmol/liter). The values of flow signal intensity (SI), signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured from base images of each MRA. The measured values were displayed graphically and analyzed statistically in relation to various parameters. RESULTS: A prolongation of repetition time resulted in a decrease of CNR of flow. As flip angles increased, SNR and CNR of flow also increased but larger flip angles of more than 40degrees rapidly saturated exit flow. As the flow velocities increased in a range of 14.7-73.6 cm/sec, SNR and CNR of flow decreased. This may be related to the phase dispersion effect of laminar flow, more dominat than the TOF effect. The addition of Gd-DTPA to water increased SNR and CNR of exit flow. There were however, no significant differences of SI, SNR or CNR of flow among the various concentrations of Gd-DTPA. CONCLUSION: An experimental MRA study using a flow phantom model was useful in understanding the flow signal characteristics of 3D TOF MRA within various MRA parameters. Our preliminary results can be used as basic data for refined flow experiments.
Angiography* ; Gadolinium DTPA ; Noise ; Signal-To-Noise Ratio ; Water

Traumatic hip joint dislocations account for 2–5% of total joint dislocations. Bilateral asymmetric hip joint dislocation with anteriorly and posteriorly dislocation is an even more rare case because it was according to G. Loupasis reported in 11 cases only since 1879. We want to report 2 cases of bilateral asymmetric hip joint dislocation with unilateral acatabulum fracture which happened in our hospital. Bilateral asymmetric dislocation of hip joint accompanied by unilateral fracture of acetabulum is a very rare case so statistical verification cannot be done. However, close examinations are required at early treatment and follow-up because the patterns of dislocation and fracture of hip joint are variable and an orthopedic emergent condition and several complications may occur at both hip joints.

Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary.

After the introduction of National Medical Insurance in 1989, the medical demand has rapidly increased. The impact of increased medical demand was followed by an increase in the number of claims in need of review. We studied a new, fair method for reducing the number of claims reviewed. we analysed 90,583 outpatient claims submitted between september and october; claims were made for services given August of 1994. We finally suggested a screening system for claims review using a statistical method of discriminant analysis of the medical costs. The results were as follows. 1. In the cut-off group, age, days of medication, number of hospital or clinic visits, and total change were significantly high The cut-off rates according to the hospital-type and existence of accompanied disease were significantly different. 2. According to ICD, the cut-off rate was highest in peripheral enthesopathies and allied syndromes(20.76%), lowest in acute sinusitis(0.93%). The mean charges were significantly different according to ICD and existence of cut-off. 3. we build discriminant functions by ICD with such discriminant variables as patient age, sex, existence of accompanied disease, number of hospital or clinic visits, and 9 detailed hospital or clinic charges included in claim. 4. we applied the discriminant function for screening those claims that were expected to be cut-off. The sensitivities comprised from 40% to 70%, and specificities from 70% to 95% by ICD. Acute rhinitis had highest sensitivity(100.00%)and other local infections of skin and subcutaneous tissue had highest specificity(98.45%). The excepted number of cut-off was 17,762(19.61%). The total sensitivity was 49.62%, the total specificity was 82.57% and the error rate was 19.66%. We lacked economic analysis such as cost-benefit analysis. But, if the few method of screening claims using discriminant analysis were applied, the number of claims in need of review will reduce considerably.
Ambulatory Care ; Cost-Benefit Analysis ; Humans ; Insurance Claim Review* ; Insurance* ; Mass Screening ; Methods* ; Outpatients ; Rheumatic Diseases ; Rhinitis ; Sensitivity and Specificity ; Skin ; Subcutaneous Tissue

We have never seen any method to cope basically with complicated situation and problems around medical reimbursement rates here in Korea since 1977 witnessed by the beginning of medical insurance. By the way researchers concerned are beginning to propose some kinds of innovative and detailed ideas to government these days. They are Diagnosis-related group(DRG)and Resource-based relative value scale(RBRVS). In the light of this situation it is so encouraging that our government can come up with that and move. In case of RBRVS research we have already been reaching even to the level of reviewing and revising methodology for its further development after naive pilot study on internal medicine and general surgery last year. However there might be something different conditions between USA and Korea to apply the same Dr. Hsiao's method and it must be vital to check so called 'total work approach' compared with 'intra-service work approach' before expanding to the whole medical fields. According to the 'Intra-service approach', the physician's work is supposed to be divided into three sub-works by the name of intraservice work, pre, and post service work. These sub-works, again should be merged together to be the pre-postwork subset through some statistical methods of the estimation process applied by Dr. Hsiao's methodology in RBRVS development later on. But in this paper that estimation process was not taken because we could have real values for all of those surveyed items related to just one specialty, OB & GY. Instead, we used some statistical comparison procedures relevant to demographic characteristics, reliability & validity and correlation analysis with American RVU(Relative value unit) between the total work and merged total work from intraservice work approach. The unit of analysis was individual physicians of OB & GY and 300 physicians were selected for each approach through statistical sampling method based on national population of OB & GY physicians in korea. And also with the thankful help of Advisory committee under Korean Association of OB & GY, questionnaires were made and mailed to the subjects, two times. As a result there were not any statistically significant differences in demographic characteristics between the two approaches except for the variable 'Response time for the questionnaire', but in other sections of comparisons, response rate, representative values, reliability & validity test, correlation analysis with American RVU, all showed 'Total approach' was not only more rational and statistically meaningful than ,'Intra-service approach' but also had considerable merits. But we are not absolutely sure about this paper's robustness. Because of some limitations, we'd rather like to suggest further researches should be followed. In that sense the first thing would be a research for the influence of doctor's haracteristics, especially 'frequency' on the rating of work and the way to define total work more clearly.
Advisory Committees ; Gynecology* ; Insurance ; Internal Medicine ; Korea ; Obstetrics* ; Pilot Projects ; Postal Service ; Surveys and Questionnaires

No abstract available.
Adenoma* ; Common Bile Duct*

The 302 patients with head-injured military personnel who had admitted to the Department of neurosurgery, Capital Armed Forces General Hospital were clinicostatistically analysed and discussed with the review of the literatures. The results were as follows: The most common cause of head injury was traffic accident(38.4% of the total cases) and the next were, in order of incidence, simple fall(9.5%), exercise(3.9%), assault(13.5%) and gun shot wound or explosive injury(7.2%). 2) Skull fracture was identified in 214 cases;98 cases of linear, 87 cases of depressed, 4 cases of basal, 2 cases mixed skull fracture. 3) The 85.7% of epidural hematomas were associated with skull fracture and the most common site of hematoma was frontal area. 4) Of all cases of subdural hematoma, acute type was prevalent(67.9%) and its main involved wite was frontotemporoparietal areas. 5) The associated injuries were found in 35.7% of patients. 6) The minor head injury of which GCS is from 13 to 15 was 148 cases, the moderate head injury of which GCS is fromn 9 to 12 was 49 cases, the severe head injury of which GCS is form 3 to 8 was 105 cases. 7) Of 105 cases of severe head injured patients the mortality was 61.9% and good recovery was 7.6%. But outcome was different according not only to GCS but also the type of lesion. 8) The operative morality was 24.1% and the good recovery was achieved 55.2% of patients. The remaining 8.9% resulted in disabled or vegetative state. 9) In the accidents of gun shot wound or explosive injury, operation mortality rate was 31.8%, but 8 cases(36.3%) were seen good recovery.
Arm ; Craniocerebral Trauma ; Glasgow Coma Scale ; Head ; Hematoma ; Hematoma, Subdural, Acute ; Hospitals, General ; Humans ; Incidence ; Military Personnel* ; Morals ; Mortality ; Neurosurgery ; Persistent Vegetative State ; Skull Fractures ; Wounds and Injuries

Necrotizing fasciitis is a relatively rare disease which mainly affects the extremities, inguinal area, and the trunk area, and it is by definition a severe acute bacterial infection which affects the fascia. One can misdiagnose the disease as simple cellulitis, thereby delaying an appropriate treatment, and the disease can rapidly spread through the fascia, causing complication such as sepsis, leaving severe loss of tissue as a sequelae. Necrotizing fasciitis of the cervical area is even a rarer disease. Once a person contracts, the disorder can spread through superficial musculoaponeurotic system and cervical fascia, quickly infecting important vascular systems and mediastinum of the craniocervical and thoracic area, which cause a serious complication from direct spread unto main organs. Therefore, in case of necrotizing fasciitis of the cervical area, active surgical treatment such as wide excision of necrotizing tissue and proper drainage of abscess and early administration of broad range antibiotics are necessary in order to prevent serious complications in main vascular system, mediastinum, or craniocervical system. We have experienced a case of necrotizing fasciitis of the cervical region in 2002, and obtained satisfactory results from wide excision, abscess drainage, local flap with skin graft, and hereby report the case with references.
Abscess ; Anti-Bacterial Agents ; Bacterial Infections ; Cellulitis ; Drainage ; Extremities ; Fascia ; Fasciitis, Necrotizing* ; Humans ; Mediastinum ; Rare Diseases ; Sepsis ; Skin ; Transplants