Authors analysed 36 cases(33 patients) of Peroneal Buoy Flap to investigate branching pattern, course, length of vascular pedicle, and perforating level of the perforating cutaneous branches from Oct. 1985 to July 1988. The results were as follows. 1. The perforating cutaneous branchea were classified into four types, the Straight Branch (18 cases), the Proximal Oblique Branch (8 cases), the Branch from Muscular Artery (8 cases), the Distal Oblique Branch(2 cases) respectively. The most common patten was Straight Branch. 2. There were 3 pathways of these branches, the most common one passed between the Soleus and Peroneus muscles(23 cases, 64%), and second one passed through the snterior part of Soleus muscle(8 cases, 22%), the third one passed through the posterior part of Peroneus muscle(5 cases, 14%). 3. The length of vascular pedicle in Buoy Flap was variable from 3cm to 15cm, but 27 cases(75%) were distributed between 4cm and 6cm. 4. The perforating level of branches were 6.3cm in average from Fibular Neck, 88% of them were distributed within 10cm. 5. Peroneal Buoy Flap in possible to reconstruct both seperated bone and skin defect in some distance by One-Stage Operation.
Arteries ; Neck ; Skin

Four total knee arthroplasties were performed in 3 patients with the diagnosis of classical Charcot's joints associated with syphilis during past 4 years from 1985 to 1988. All patients had positive reaction in serology test(VDRL, TPHA). We corrected the bone loss and severe joint instability with allograft or autogenous bone grafting and ligament balancing. The knee score was increased from preoperative 37 points to postoperative 87.3 points. We expect that total knee arthroplasty may be the alternative treatment to the conservative treatment or knee arthrodesis in Charcots joints.
Allografts ; Arthrodesis ; Arthropathy, Neurogenic ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Bone Transplantation ; Diagnosis ; Humans ; Joint Instability ; Knee ; Ligaments ; Syphilis

Magnetic resonance imaging has been recognized as more suitable method than radiography and bone scan for the early detection of avascular necrosis of the femoral head. Segmental collapse is the most important factor in the prognosis of patient with avascular necrosis. The authors studied the appearance of avascular necrosis with both radiography and magnetic resonance imaging and then determined which lesions remained unchanged, progressed or led to collapse, as determined wih follow-up radiography in the 61 radiographically negative avascular necrosis of the femoral heads. 1. The necrosis-progression rates according to the extent were 36% in Extent A, 83% in Extent B, and 93% in Extent C. The necrosis-progression rate was significantly correlated with the extent of necrosis initially involved. 2. The necrosis-progression rates according to the location were 37% in Type I, 70% in Type II, and 95% in Type III. The necrosis-progression rate was significantly correlated with the weight bearing area of necrosis initially involved. 3. There was no correlation between necrosis-progression rate and signal intensity. 4.All of the cases which had combinations of the Extent C, and Type III location showed progression. 5. None of the femoral heads that had been treated at the radiographically negative stage was collapsed, but 35% of the femoral heads those had been treated at the radiographically positive stage were collapsed. 6. In the cases which were treated early, all of the Extent C, Type III were collapsed, but none of the Extent A, Type I were collapsed. In conclusion, magnetic resonance imaging is useful for evaluation of the risk of collapse or for anticipation of the prognosis of the affected hip joint as well as for the early diagnosis of radiographically negative avasular necrosis of the femoral head.
Early Diagnosis ; Follow-Up Studies ; Head ; Hip Joint ; Humans ; Magnetic Resonance Imaging ; Methods ; Necrosis ; Prognosis ; Radiography ; Weight-Bearing

No abstract available.
Humans ; Lupus Erythematosus, Systemic* ; Renal Veins* ; Thrombosis*

BACKGROUND: Basal cell carcinoma(BCC) is the commonest type of skin malignacy, and its incidence is increasing. As a result, the number of cases requiring treatment by dermatologists may also be increasing. OBJECTIVE: The aim of this study was to clarify the presentation pattern of BCC and to assessce the surgical treatment used in the dermatological surgery clinics in Seoul National University Hospital and Seoul City Boramae Hosptial between 1994 to 1998. METHOD: We reviewed the medical records and checked clinical aspects and surgical treatment methods. RESULTS: The Total number of patients was 33. There were 21 Females and 12 males. The Mean age was 63.1. The most common anatomical site was the face and scalp(30 cases, 91%). The mean size of the tumor was 12.2 by 9.6 mm. BCCs were removed by complete surgical excision with a normal skin margin of 2 to 4 mm. The local flap was most commonly used to repair surgical wounds (55%) and primary closure was used in 39% of patients. A Pedicle flap and full thickness skin graft were also used in surgical defect reconstruction. CONCLUSION: With increasing public awareness and earlier presentation there may be a reduction in tumor size at the time of diagnosis. As most BCCs are found on the head and neck and are usually more or less than 1cm in diameter, it is thought that appropriate education of surgical skills should be needed and offered.
Carcinoma, Basal Cell* ; Diagnosis ; Education ; Female ; Head ; Humans ; Incidence ; Male ; Medical Records ; Neck ; Seoul ; Skin ; Transplants ; Wounds and Injuries*

PURPOSE: This study aims to investigate preexposure prophylaxis and postexposure prophylaxis of rabies that the National Medical Center (NMC) handled and to check whether appropriate measures were performed according to the recent domestic and overseas guidelines after animal bites. METHODS: This study surveyed 41 people who were 18 years or under and received preexposure and postexposure prophylaxis of rabies at the NMC from November 2006 to December 2011. Their medical records were reviewed for their age, gender, the reason for preexposure prophylaxis, the body sites of animal bite, the kind of the animal that bit children, the region where the biting occurred and rabies vaccination and inoculation of immunoglobulin. RESULTS: Eleven children took rabies vaccination for preexposure prophylaxis and 30 children received post exposure prophylaxis of rabies. Of patients who were bitten by unvaccinated animals including wild animals or by animals which were not certain to be vaccinated, 50% (13 of 26 children) received postexposure prophylaxis, while 75% (3 of 4 children) of patients who were bitten by vaccinated animals received postexposure prophylaxis of rabies. Ten of 30 bitten patients knew whether or not the biting animals had received rabies vaccination. Of them, four people (40%) were bitten by animals which had received rabies vaccination. CONCLUSION: To prevent the occurrence of rabies, people and health care providers need to correctly understand latest guideline for rabies preexposure and postexposure prophylaxis and the information for bitten patient, biting animal and area at bitten by animal should be accurately recorded.
Animals ; Animals, Wild ; Bites and Stings ; Child ; Child Health ; Health Personnel ; Humans ; Isothiocyanates ; Medical Records ; Post-Exposure Prophylaxis ; Rabies ; Vaccination

From August 1976 to February 1997, we have experienced 29 cases of rapidly destructive coxarthrosis in 23 patients who represented severe hip pain and destruction of the femoral head more than 50% within one year. The retrospective analyses of clinical, radiographic and operative findings of 2090 hips in 1534 patients, who have been diagnosed as ischemic necrosis of femoral head were performed to investigate the correlation between ischemic necrosis of the femoral head and rapidly destructive coxarthrosis. The incidence of rapidly destructive coxarthrosis was 1 % of the overall ischemic necrosis of the femoral head. The average duration of hip pain was 9 months. The average age of the patients was 56 years old and most of them were male. The cultures of synovial fluid for bacteria were negative in all cases except one case of non-pathogenic organism. But, the erythrocyte sedimentation rate and C-reactive protein were elevated. The pathologic findings were not different from the ischemic necrosis except the destruction of articular cartilage. Therefore, we concluded that rapidly destructive coxarthrosis is a subtype of ischemic necrosis of the femoral head.
Bacteria ; Blood Sedimentation ; C-Reactive Protein ; Cartilage, Articular ; Femur Head Necrosis ; Head ; Hip ; Humans ; Incidence ; Male ; Middle Aged ; Necrosis ; Osteoarthritis, Hip* ; Retrospective Studies ; Synovial Fluid

Total hip arthroplasty for ankylosed hip has a higher risk of failure due to the poor condition of the hip abductors and the altered configuration of the bone, which lead to poor positioning or fixation of the prosthesis. Fifty-one hips (42 patients) converted to total hip arthroplasty between March 1983 and March 1994 have been reviewed three to thirteen years six months after operation. The average period of follow-up was four years nine months. Twenty six of the patients were men and sixteen were women. The average age at the time of operation was 40 years old (range,19 to 70 years). Among the 51 hips, bony ankylosis were 27 hips and fibrous ankylosis were 24 hips, spontaneous ankylosis were 40 hips and surgical ankylosis were 11 hips. The duration of hip fusion was 13 years six months in the bony ankylosis and 16 years one month in the fibrous ankylosis. Preoperatively 33 cases had low back pain, ipsilateral or contralateral knee or hip pain. In asymptomatic 18 cases, conversion total hip arthroplasty was also performed for the management of functional disabilities due to severe malpositioned ankylosis. At the time of the last follow-up, 25 cases were free from pain and six patients had a mild degree pain on the hip, knee or thigh. In bony ankylosis, the postoperative average hip motion ranged from 1.1 degrees to 93.2 degrees (average arc of motion of 92.1 degrees). In fibrous ankylosis, the postoperative average hip motion ranged from 1.7 degrees to 96.6 degrees (average arc of motion of 94.9 degrees). The average Harris hip score was improved from 66 to 86.9 in bony ankylosis and from 49 to 89.5 in fibrous anklyosis. The postoperative leg length discrepancy was 1.1 cm in average. The postoperative complications included heterotropic ossification in 25 cases (49%), cup loosening in two cases (3.9%) and stem loosening in three cases (5.6%). As for the clinical results, 24 cases (89%) of bony ankylosis and 23 cases (96%) of fibrous ankylosis had satisfactory functional results at the last follow-up. In conclusion, the conversion total hip arthroplasty could provide functional improvement, pain relief and especially correction of leg length discrepancy in most cases of ankylosed hip.
Adult ; Ankylosis ; Arthroplasty, Replacement, Hip* ; Female ; Follow-Up Studies ; Hip* ; Humans ; Knee ; Leg ; Low Back Pain ; Male ; Postoperative Complications ; Prostheses and Implants ; Thigh

The aim of the present study was to investigate the mRNA expression of several cytokines which were not reported previously from interface tissues around loose cemented acetabulum to obtain better understanding of the biological mechanisms connected with aseptic loosening and osteolysis of THA. We investigated mRNA expression for several cytokines (interleukin-1 alpha [IL-l~a], IL-lp, IL-2, IL-2 receptor[2R], IL-4, IL-5, IL-8, IL-10, transforming growth factor-beta [TGF-p], and interferon- gamma [IFN-y]) by reverse transcription-polymerase chain reaction (RT-PCR) and release of metalloproteinase (MMP)-2 and MMP-9 from the cement-bone interface tissues around five loose polyethylene acetabular components. We did not include TNF-a and IL-6 because the biologic effect of the former is so similar to that of IL-1, and the latter fails to stimulate prostaglandin E, or collagenase production by fibroblsts or synovial cells. Expression of mRNA for IL-1p was detected in four, IL-2R and IL-8 in three, IL-10 and TGF-p in two of five interface tissues .No expression of mRNA for IL-la, IL-2, IL-4, IL-5, and IFN-p was detected. Zymographic analysis for gelatinase/type IV collagenase revealed gelatinolytic bands corresponding to metalloproteinase(MMP)-2 and MMP-9 in cemenl-bone interface tissues. Activated cells phagocytose particles in cement-bone interface tissues expressed more cytokines mRNA than previously known to be related to periprosthetic bone resorption, and secreted metalloproteinases associated with extracellular matrix degradation and fibrosis.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Bone Resorption ; Collagenases ; Cytokines* ; Extracellular Matrix ; Fibrosis ; Interleukin-1 ; Interleukin-10 ; Interleukin-2 ; Interleukin-4 ; Interleukin-5 ; Interleukin-6 ; Interleukin-8 ; Metalloproteases* ; Osteolysis ; Polyethylene ; RNA, Messenger*

BACKGROUND: The interest of patients with chest pain and normal coronary arteries has been increased since 1960. From the year 1973, the syndrome representing these characteristics has been classified as syndrome X. Treadmill test and exercise TI-201 SPECT are important in the diagnosis of syndrome X. This study was designed to evaluate the clinical value of exercise TI-201 SPECT and the difference of clinical characteristics between exercise TI-201 SPECT positive(Group A) and negative (Group B) in patients with chest pain and normal coronary angiogram. METHODS: Twenty seven patients with chest pain and normal coronary angiogram underwent echocardiogram and exercise TI-201 SPECT. Patients received 2 mCi of thallium intravenously during exercise, redistribution images were performed 4 hour later and second dose of 1 mCi of thallium was injected at rest immediately thereafter. These three sets of image(stress, redistribution and reinjection) were analyzed. RESULTS: 1) 12 of 16 patients in Group A, none of 11 patients were positive on exercise treadmill test(p<0.005). 2) The incidence of systemic hypertension in Group A was significant greater than Group B(p<0.05). 3) The left ventricular end diastolic pressure was significantly higher in Group A than in Group B (p<0.05). CONCLUSION: The exercise TI-201 SPECT is a useful method to evaluate the patients with chest pain and normal coronary angiogram and the reversible perfusion defects on the exercise TI-201 SPECT might be related to systemic hypertension and elevated left ventricular end diastolic pressure.
Blood Pressure ; Chest Pain* ; Coronary Vessels ; Diagnosis ; Exercise Test ; Humans ; Hypertension ; Incidence ; Perfusion ; Thallium ; Thorax* ; Tomography, Emission-Computed, Single-Photon*