Sixteen microvasular free flap transfers have performed during recent two years in this department, which was first attempt in Korea. Neurovascular free flap was nine and vascular free flap was seven. The donor flaps were thirteen dorsalis pedls falps, two groin flaps and one latissimus dorsi flap respectively. The recipient sites were heel pad loss, vital organ exposure and scar contracture lesions in extremity. Their main cause of soft tissue defect was traumatic in all. All patients have experienced more than two times of split thickness skin graft before free flap transfer. The success rate of vascular free flap transfer was 94%. The only one failure case was due to venous thrombosis, but secondary split thickness skin graft performed with satisfactory result. The follow up period was from 5 months to 20 months. Sweating in transferred free flap was found at all neurovascular free flap within postoperative 4 months. Adequate 2-point discrimination was obtained at six patients of nine neurovascular free flaps and protective sensation seems to progressively improve in remained three patients. Two point discrimination was shortened at hand after neurovascular dorsalis pedis flap transfer in two cases. The weight bearing function at heel pad region and tactile sensation at hand have satisfactorily recovered after free flap transfer. Free flap transfer have many advantages compare to conventional skin graft, such as shorter therapeutic time, lesser physical and economic burdens, primary covering to vital organs and protective sensation of neurovascular free flap transfer. The most important factors are meticulous microvascular operation technique and anatomic knowledge.
Cicatrix ; Contracture ; Discrimination (Psychology) ; Extremities ; Follow-Up Studies ; Free Tissue Flaps ; Groin ; Hand ; Heel ; Humans ; Korea ; Microsurgery ; Sensation ; Skin ; Superficial Back Muscles ; Sweat ; Sweating ; Tissue Donors ; Transplants ; Venous Thrombosis ; Weight-Bearing

It is notoriously difficult to obtain a sound bony union of congenital paeudarthrosis of tbe tibia with conventional methods. This paper is the results of using the free vascularized fibular graft for congenital pseudarthorsis of the tibia in 7 patients since 1978 in this hospital, which is the first attempt in Korea. During the follow-up periods from 9 months to 32 months, 5/7 patients(71%) had good or excellent bony union, 2 patients had bone resorption at tbe distal site of grafted bone and required a second supplementary cancellous bone graft with electrode insertion. So it is thought that the free vascularized fibular graft is one of good methods of treatment for congenital pseudarthrosis of the tibia.
Bone Resorption ; Electrodes ; Follow-Up Studies ; Humans ; Korea ; Pseudarthrosis ; Tibia ; Transplants

We report a case of calcific bursitis of the shoulder in four-year-old boy who had severe pain and limitation of motion of the left shoulder joint for three days. Radiographs revealed the oval radiopaque lesion in the subacormial space, and the MR signal intensity of the mass was moderate on T2WI. Histological examination of the mass showed acute necrotizing inflammation with calcification.
Bursitis ; Humans ; Inflammation ; Male ; Shoulder ; Shoulder Joint

Purpose: Urinary tract infections (UTIs) are the most common and serious bacterialinfections in children. Therefore, early diagnosis of vesicoureteral reflux (VUR)for treatment planning and the identification of noninvasive markers that canpredict renal injury are important in patients with UTIs. We analyzed the clinicalfeatures of pediatric UTIs commonly encountered by general practitioners and reinterpretedthe blood tests and imaging findings to identify the important clinicalpredictive markers of VUR in order to selectively perform VCUG. Methods: This retrospective study was performed among 183 children diagnosedwith a UTI or acute pyelonephritis. Results: The most significant predictor of high grade and bilateral VUR identifiedusing area under the curve analyses was hydronephrosis on kidney ultrasoundimages with renal cortical defects on dimercaptosuccinic acid (DMSA) kidney scansimultaneously, followed by hydronephrosis only on kidney ultrasound. Conclusion The presence of hydronephrosis on kidney ultrasound images or corticaldefects or asymmetric kidneys on the DMSA kidney scans can be predictivemarkers of VUR, reducing the need for VCUG. Our study can thus help minimizethe exposure to radiation among patients through selective VCUG.

BACKGROUND: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. METHODS: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST), Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. RESULTS: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P < 0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). CONCLUSIONS: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50's side effects.
Analgesia ; Anesthesia ; Anesthesia, Local ; Biopsy ; Breast ; Dizziness ; Humans ; Incidence ; Outpatients ; Piperidines ; Propofol ; Vital Signs

PURPOSE: Sorafenib, a multikinase inhibitor, is the standard therapy for patients with advanced-stage hepatocellular carcinoma (HCC). However, resistance develops to the treatment, therefore, we tried to unravel the underlying mechanism in the resistance of HCC cells to sorafenib via the development of more effective therapeutic strategies. MATERIALS AND METHODS: Various liver cancer cell lines were treated with either sorafenib only or with sorafenib after infection of adenovirus expressing short hairpin RNA (shRNA) against transforming growth factor-β (TGF-β) and p38 activity was examined using western blotting. RESULTS: p38 MAP kinase activity was inhibited by low concentrations of sorafenib, which could potentially lead to sorafenib resistance in HCC cell lines. Subsequently, we used constitutive form of MKK3/6 (MKK3/6E) to confirm that massive cell death was induced by the activation of p38, and demonstrated the ability to activate p38 without any stimulation. In addition, sorafenib resistance was reduced by the activation of p38. Subsequently, we confirmed that TGF-β shRNA effectively recovered the phosphorylation of p38 inhibited by sorafenib, and increased the sensitivity of HCC cells to sorafenib, thereby inducing cell death and overcoming the resistance of HCC cells to sorafenib. CONCLUSION: Our study provides a new therapeutic strategy for HCC that overcomes the resistance of HCC to sorafenib by down-regulation of TGF-β.
Adenoviridae ; Blotting, Western ; Carcinoma, Hepatocellular* ; Cell Death ; Cell Line ; Down-Regulation* ; Humans ; Liver Neoplasms ; p38 Mitogen-Activated Protein Kinases ; Phosphorylation ; RNA, Small Interfering

Chorea-acanthocytosis (ChAc) is a rare hereditary disorder characterized by involuntary choreiform movements and erythrocytic acanthocytosis. Pharmacotherapy for control of involuntary movements has generally been of limited benefit. Deep brain stimulation (DBS) has recently been used for treatment of some refractory cases of ChAc. We report here on the effect of bilateral high-frequency DBS of globus pallidus interna in a patient with ChAc.
Abetalipoproteinemia ; Chorea ; Deep Brain Stimulation* ; Drug Therapy ; Dyskinesias ; Globus Pallidus* ; Humans ; Neuroacanthocytosis*

STUDY DESIGN: A retrospective analysis of the results of various methodologies for the surgical treatment of an unstable burst fracture with posterior column injuries. OBJECTIVES: To compare the radiological and clinical results in unstable burst fractures, treated with various surgical methodologies (anterior, posterior and combined fusion), and to confirm their efficacy. LITERATURE REVIEW SUMMARY: Many authors recommended various surgical methods for the treatment of an unstable burst fracture, and of these, combined fusion is recommended for the preservation of stability. MATERIALS AND METHODS: A retrospective review of results was carried out on 22 patients, confirmed with an unstable burst fracture associated with a posterior column injury, between Nov. 1996 and Mar. 2003. The preoperative plane x-ray, CT and MRI, and the last postoperative follow up plane X-ray and CT, in 22 unstable burst fracture patients, were reviewed. The authors looked for laminar fracture, facet injury and inter-spinous widening in the plane x-ray, canal compromise on the CT, and a posterior ligament injury and dural tear on the MRI. The neurological injury was evaluated using the Bardford and McBride criteria and the clinical result with the Denis' pain and work scale. RESULTS: In the anterior fusion group, the radiological findings showed 3 laminar fractures, 2 facet injuries, 7 inter-spinous widening and 8 posterior ligament injuries. In the posterior fusion group, they showed 5 laminar fractures, 4 facet injuries, 5 inter-spinous widening and 5 posterior ligament injuries. In the combined fusion group, they showed 5 laminar fractures, 4 facet injuries, 4 inter-spinous widening and 5 posterior ligament injuries. The average canal compromise was 54.3% in cases of anterior fusion, 20.9% of posterior fusion and 74% of the combined fusion groups. A dural tear was found in 1 each of the anterior and posterior and 4 of the combined group. From the clinical results, improvements of the neurology in the anterior, posterior and combined groups were 2.0, 1.7 and 1.3 degrees, respectively. From the Denis' pain & work scale better than good degrees were shown in 3 of the anterior, 4 of the posterior and 2 of the combined groups. CONCLUSIONS: In conclusion, there were no differences in the improvements of the neurology and clinical results according to the surgical methodology employed. However, the use of combined fusion is recommended for the preservation of stability in an unstable burst fracture with combined posterior ligament and bony injuries as well as with severe canal compromise.
Follow-Up Studies ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Neurology ; Retrospective Studies ; Tears

STUDY DESIGN: A retrospective analysis of the results of various methodologies for the surgical treatment of an unstable burst fracture with posterior column injuries. OBJECTIVES: To compare the radiological and clinical results in unstable burst fractures, treated with various surgical methodologies (anterior, posterior and combined fusion), and to confirm their efficacy. LITERATURE REVIEW SUMMARY: Many authors recommended various surgical methods for the treatment of an unstable burst fracture, and of these, combined fusion is recommended for the preservation of stability. MATERIALS AND METHODS: A retrospective review of results was carried out on 22 patients, confirmed with an unstable burst fracture associated with a posterior column injury, between Nov. 1996 and Mar. 2003. The preoperative plane x-ray, CT and MRI, and the last postoperative follow up plane X-ray and CT, in 22 unstable burst fracture patients, were reviewed. The authors looked for laminar fracture, facet injury and inter-spinous widening in the plane x-ray, canal compromise on the CT, and a posterior ligament injury and dural tear on the MRI. The neurological injury was evaluated using the Bardford and McBride criteria and the clinical result with the Denis' pain and work scale. RESULTS: In the anterior fusion group, the radiological findings showed 3 laminar fractures, 2 facet injuries, 7 inter-spinous widening and 8 posterior ligament injuries. In the posterior fusion group, they showed 5 laminar fractures, 4 facet injuries, 5 inter-spinous widening and 5 posterior ligament injuries. In the combined fusion group, they showed 5 laminar fractures, 4 facet injuries, 4 inter-spinous widening and 5 posterior ligament injuries. The average canal compromise was 54.3% in cases of anterior fusion, 20.9% of posterior fusion and 74% of the combined fusion groups. A dural tear was found in 1 each of the anterior and posterior and 4 of the combined group. From the clinical results, improvements of the neurology in the anterior, posterior and combined groups were 2.0, 1.7 and 1.3 degrees, respectively. From the Denis' pain & work scale better than good degrees were shown in 3 of the anterior, 4 of the posterior and 2 of the combined groups. CONCLUSIONS: In conclusion, there were no differences in the improvements of the neurology and clinical results according to the surgical methodology employed. However, the use of combined fusion is recommended for the preservation of stability in an unstable burst fracture with combined posterior ligament and bony injuries as well as with severe canal compromise.
Follow-Up Studies ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Neurology ; Retrospective Studies ; Tears

An 8-year-old, castrated, male Rottweiler was referred for evaluation of chronic right thoracic limb lameness and a progressively growing mass surrounding the right elbow joint. On admission, the dog's general health was good, without abnormalities detected on physical examination. The dog was diagnosed with periarticular histiocytic sarcoma. Although draining lymph nodes and lung metastases were suspected, palliative amputation was performed. Localized histiocytic sarcomas, with destructive lesions involving multiple bones of a joint and periarticular soft-tissue masses, are uncommon in dogs. This case report presents clinical findings, imaging characteristics, and histopathologic and immunohistochemical features of a periarticular joint histiocytic sarcoma.
Amputation ; Animals ; Child ; Dogs ; Elbow Joint ; Extremities ; Histiocytic Sarcoma ; Humans ; Immunohistochemistry ; Joints ; Lung ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Physical Examination