Healing is an intricate, interdependent process that involves complex interactions between cells, the microcellular environment, biochemical mediators and extracellular matrix molecules. The goals of wound healing are to minimize bloods loss, to replace any defect with new tissue, and to restore an intact epithelial barrier as rapidly as possible. The rate of wound healing is limited by the available vascular supply and the rate of formation of new capillaries and matrix molecules, which are heavily influenced by locally-acting growth factors that affect proliferation, angiogenesis, chemotaxis, gene expression, proteinases, and protein production. We present a new method for wound control and treatment, the V.A.C (vacuum-assisted closure) technique. It places open-cell foam dressing into the wound cavity and applies subatmospheric pressure. The application of subatmospheric pressure accelerates the rate of wound healing by the foollowing two mechanisms: 1. Removal of excessive interstitial fluids, which decrease localized edema, reduce concentration of inhibitory factors, and increase local blood flow. 2. Transmission of mechanical forces to surrounding tissues with resultant deformation of the extracellular matrix and cells, which then increase protein and matrix synthesis as well as cell proliferation. We applied it to 17 patients: 1 Livedo vasculitis, 1 burned by flame 3 pressure sores, 1 extravasation injury, 1 wound infection, 2 wound disruption, and 8 diabetes mellitus feet. In the end, most of the remaining wounds were treated with a simple split-thickness skin graft and the results were encouraging. We concluded that the V.A.C technique may be an effective substitute to help promote wound healing. It could be especially helpful in chronic complicated wounds in aging or debilitated patients who can not tolerate aggressive surgical procedures.
Aging ; Bandages ; Burns ; Capillaries ; Cell Proliferation ; Chemotaxis ; Diabetes Mellitus ; Edema ; Extracellular Fluid ; Extracellular Matrix ; Foot ; Gene Expression ; Humans ; Intercellular Signaling Peptides and Proteins ; Peptide Hydrolases ; Pressure Ulcer ; Skin ; Transplants ; Vasculitis ; Wound Healing* ; Wound Infection ; Wounds and Injuries*

OBJECTIVE: The purpose of this study was to evaluate the difference for each variable on plain radiologic study of the foot between weighted and non-weighted routine plain anterior-posterior and lateral views in flatfoot children diagnosed by Harris mat footprint. METHOD: Both feet of thirty-four children over two-year old, who had been diagnosed as flatfooted by modified Rose' classification using Harris mat footprint were included. We studied plain roentgenogram images, including anterior-posterior and lateral views, in both standing (weighted) and sitting (non weighted) position of the feet of the patients. We measured the following variables; arch height (AH), calcaneal pitch (CP), talocalcaneal angles from lateral view (TCALA) and anterior-posterior view (TCAAP), talo-first metatarsal angles from the lateral (TFML) and anterior-posterior view (TFMA). RESULTS: Each variable revealed no significant difference between boys and girls (p>0.05); neither was there any significant difference noted in each parameter between the right and left feet (p>0.05). All the variables of plain foot roentgenogram on weighted state were significantly different from the data of non-weighted state, except TCAAP (p<0.05). CP was the only parameter which showed significant difference according to severity of flatfoot by modified Rose'classification. CONCLUSION: Because most of the flatfoot in childhood is hypermobile type, it is necessary to take plain radiologic studies of the feet both in weighted and non weighted state and to compare both data of each variable. In addition, it is prefer to use plain radiologic study of foot both in weighted and non weighted state with footprint as the screening method of pediatric flatfoot lesions.
Child ; Classification ; Female ; Flatfoot* ; Foot ; Humans ; Mass Screening ; Metatarsal Bones ; Radiography

Circumcaval ureter is one of the congenital anomaly in which aberrant development of the inferior vena cava (IVC) causes compression of the deviated ureter medially behind the IVC. The incidence is approximately one in 1500 cadavers and is three to four times more common in male. Although the lesion is congenital, symptoms attributable to this anomaly usually appear in young adulthood. This is a case of 17-year-old spinal cord injured man with a circumcaval ureter who was diagnosed as right hydronephrosis by routine evaluation for neurogenic bladder, incidentally. Suprapubic cystostomy was done for prevention of further urologic complication and the severity of hydronephrosis was not aggravated in follow up studies after 6 months. We suggest early routine evaluation for neurogenic bladder is very important for prevention of developing urologic complication caused by congenital urologic anomaly in the patients with spinal cord injury.
Adolescent ; Cadaver ; Cystostomy ; Follow-Up Studies ; Humans ; Hydronephrosis* ; Incidence ; Male ; Retrocaval Ureter* ; Spinal Cord Injuries ; Spinal Cord* ; Ureter ; Urinary Bladder, Neurogenic ; Vena Cava, Inferior

Purpose: It is unclear whether performing endosonography first in non–small cell lung cancer (NSCLC) patients with radiological N1 (rN1) has any advantages over surgery without nodal staging. We aimed to compare surgery without endosonography to performing endosonography first in rN1 on the overall survival (OS) of patients with NSCLC. Materials and Methods: This is a retrospective analysis of patients with rN1 NSCLC between 2013 and 2019. Patients were divided into ‘no endosonography’ and ‘endosonography first’ groups. We investigated the effect of nodal staging through endosonography on OS using propensity score matching (PSM) and multivariable Cox proportional hazard regression analysis. Results: In the no endosonography group, pathologic N2 occurred in 23.0% of patients. In the endosonography first group, endosonographic N2 and N3 occurred in 8.6% and 1.6% of patients, respectively. Additionally, 51 patients were pathologic N2 among 249 patients who underwent surgery and mediastinal lymph node dissection (MLND) in endosonography first group. After PSM, the 5-year OSs were 68.1% and 70.6% in the no endosonography and endosonography first groups, respectively. However, the 5-year OS was 80.2% in the subgroup who underwent surgery and MLND of the endosonography first group. Moreover, in patients receiving surgical resection with MLND, the endosonography first group tended to have a better OS than the no endosonography group in adjusted analysis using various models. Conclusion In rN1 NSCLC, preoperative endosonography shows better OS than surgery without endosonography. For patients with rN1 NSCLC who are candidates for surgery, preoperative endosonography may help improve survival through patient selection.