The provision of adequate soft tissue cover for a complex hand and forearm wound-dirty, infected and exposed bone can be a challenging problem. Conventionally, a distant flap or free flap have been used, but these have been associated with several problems such as joint stiffness, risk of microsurgical procedures, negligible donor site morbidity, prolonged operation time and economic restriction. As well, fasciocutaneous flap has been the limitation of infection control. In these situations, the ipsilateral muscle flap provides the ideal cover with its rich blood supply and single operative field. Previously described by Lendrum(1980), by Lae et al.(1981), and later by McGeorge(1991), the brachioradilis muscle is the most superficial muscle on the radial side of the forearm. Its flap is based on the radial artery and venae comitantes. From August 1996 to October 1997, we performed branchioradialis muscle flap in seven patients. Despite the sacrifice of the major hand artery, brachioradialis muscle flap has many advantages including the reliability of flap survival, easy dissection, early mobilization and absence of functional and aesthetic problems at the donor site. It is a relatively simple and rapid method for resurfacing soft tissue defect in the hand and forearm. We obtained satisfactory and reliable results.
Arteries ; Early Ambulation ; Forearm* ; Free Tissue Flaps ; Hand* ; Humans ; Infection Control ; Joints ; Radial Artery ; Tissue Donors

BACKGROUND: To prevent the platelet refractoriness, repeated plateletpheresis is often required in HLA matched single-donors. Korean Transfusion Standard permits the repeated plateletpheresis of a single donor at 72-hour intervals. To evaluate this standard, hematological responses of donors were assessed after plateletpheresis by Haemonetics V50 (Haemonetics Co., USA). METHODS: The pre- and post-donated hematological indices of 22 healthy donors(17 males and 5 females) were evaluated. Single donated donors were 12 males and 4 females. Multiple donated donors were 5 males and one female. Post-donated platelet counts were measured immediately, 6 hours, 12 hours, 1 day, 3 days, 5 days, 7 days and 9 days after plateletpheresis. Platelet aggregation test, serum protein, PT, and aPTT were also examined before and after platelet collection. RESULTS: Only 9 (56.2%) of 16 single-donated donors and 4 (66.7%) of 6 multiple donated donors showed normal restoration up to 97% of platelet counts of pre-donation levels at the day 3. In 9 (75%) of 12 single donated males restoration of platelet count was observed within 3 days, but 3 (75%) of 4 single donated females showed restoration of platelet count within 5 days. Changes of other indices were not significantly different between the pre- and post-donations of platelet. CONCLUSIONS: Although no clinical complication was noted after plateletpheresis, these data suggested that Korean Transfusion Standard on plateletpheresis should be reconsidered.
Blood Platelets ; Female ; Humans ; Male ; Platelet Aggregation ; Platelet Count ; Plateletpheresis* ; Tissue Donors*

BACKGROUND: Many studies in severe acute pancreatitis have demonstrated an increase in intestinal permeability, but not in mild acute pancreatitis. The current methods to measure intestinal permeability need much time and also laborious work. Therefore, we investigate the changes of intestinal permeability in patients with mild acute pancreatis and clinical predictive factor for the intestinal permeability in patients with acute pancreatitis. METHODS: The intestinal permeability were measured in 14 normal heathy controls, 41 patients with mild acute pancreatitis (alcoholic 14, biliary 12, idiopathic 15) by measuring 24 hour urine excretion of 51Cr-EDTA (51Cr-ethylenediaminetetraacetic acid) for evaluation of the gut barrier dysfunction. We compared the intestinal permeability with clinical characteristics of patients. RESULTS: The intestinal permeability was significantly increased in patients with mild acute pancreatitis (6.01+/-4.11%, p<0.001) versus control subjects (1.86+/-0.52%). There was no significant difference in the intestinal permeability among the patients with alcoholic, biliary and idiopathic pancreatitis. The correlation was not found between intestinal permeability and clinical characteristics in patients with mild acute pancreatitis. CONCLUSIONS: The intestinal permeability is increased in patients with mild acute pancreatitis regardless of etiology of pancreatitis. The predictive factor for gut barrier dysfunction is not detected in patients with mild acute pancreatitis.
Alcoholics ; Humans ; Pancreatitis* ; Permeability*

No abstract available.
Drainage* ; Prognosis*

PURPOSE: A prospective study was performed to compare the efficacy and safety of intravesical mitomycin C (MMC) instillation for the prophylaxis of bladder cancer at different concentrations (30 mg or 40 mg). MATERIALS AND METHODS: Ninety-seven patients that received complete transurethral resection for superficial bladder cancer were divided into two-randomized groups. One group (n=53) received 30 mg and the other group (n=44) received 40 mg dose of MMC weekly for 8 weeks, which was followed monthly for 10 months as maintenance therapy. The recurrence rates and side effects in both groups were recorded. The mean follow-up period was 32.4 months in the 30 mg group, and 32.0 months in the 40 mg group. RESULTS: The overall one and two year recurrence rates were 19% and 24% in the 30 mg group, and 12% and 22% in the 40 mg group, which was not significantly different (p>0.05). Most of the side effects were mild and transient. Moreover, the rates of the individual side effects were not statistically different in the two groups. CONCLUSION: Our comparison of 30 mg and 40 mg intravesical MMC instillation showed no difference in either response or side effects. Thus, we tentatively conclude that we can use 30 mg instead of 40 mg as an intravesical MMC instillation dose.
Administration, Intravesical* ; Follow-Up Studies ; Humans ; Mitomycin* ; Prospective Studies* ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Purpose: Pathologic T3b (pT3b) prostate cancer, characterized by seminal vesicle invasion (SVI), exhibits variable oncological outcomes post–radical prostatectomy (RP). Identifying prognostic factors is crucial for patient-specific management. This study investigates the impact of bilateral SVI on prognosis in pT3b prostate cancer. Materials and Methods: We evaluated the medical records of a multi-institutional cohort of men who underwent RP for prostate cancer with SVI between 2000 and 2012. Univariate and multivariable analyses were performed using Kaplan-Meier analysis and covariate-adjusted Cox proportional hazard regression for biochemical recurrence (BCR), clinical progression (CP), and cancer-specific survival (CSS). Results: Among 770 men who underwent RP without neo-adjuvant treatment, median follow-up was 85.7 months. Patients with bilateral SVI had higher preoperative prostate-specific antigen levels and clinical T category (all p < 0.001). Extracapsular extension, tumor volume, lymph node metastasis (p < 0.001), pathologic Gleason grade group (p < 0.001), and resection margin positivity (p < 0.001) were also higher in patients with bilateral SVI. The 5-, 10-, and 15-year BCR-free survival rates were 23.9%, 11.7%, and 8.5%; CP-free survival rates were 82.8%, 62.5%, and 33.4%; and CSS rates were 96.4%, 88.1%, and 69.5%, respectively. The bilateral SVI group demonstrated significantly lower BCR-free survival rates, CP-free survival rates, and CSS rates (all p < 0.001). Bilateral SVI was independently associated with BCR (hazard ratio, 1.197; 95% confidence interval, p=0.049), CP (p=0.022), and CSS (p=0.038) in covariate-adjusted Cox regression. Conclusion Bilateral SVI is a robust, independent prognostic factor for poor oncological outcomes in pT3b prostate cancer.

Constipation is a prevalent, often chronic, gastrointestinal motility disorder. Bisacodyl, a stimulant laxative, is widely used to treat constipation in adults and children. This drug is usually safe, but it has some side effects including diarrhea, abdominal pain, colitis, and proctitis. There have been reports that rectal administration of bisacodyl could cause injury to the rectal mucosa by mechanical and chemical mechanisms. However, there has been no report of severe proctitis with rectal ulcers in patients taking oral bisacodyl. In this report, we describe the case of an 80-year-old woman with severe rectal ulcers and proctitis after taking oral bisacodyl for several days, and review the literature.
Abdominal Pain ; Administration, Rectal ; Adult ; Aged, 80 and over ; Bisacodyl* ; Child ; Colitis ; Constipation ; Diarrhea ; Female ; Gastrointestinal Motility ; Humans ; Mucous Membrane ; Proctitis* ; Rectum ; Ulcer*

We report here a case of strongyloidiasis in a 72-year-old diabetic patient (woman) accompanied by gastrointestinal stromal tumor receiving imatinib therapy, first diagnosed as hypereosinophilic syndrome and treated with steroids for uncontrolled eosinophilia. She suffered from lower back pain and intermittent abdominal discomfort with nausea and diagnosed with gastrointestinal stromal tumor. After post-operative imatinib treatment eosinophilia persisted, so that steroid therapy was started under an impression of hypereosinophilic syndrome. In spite of 6 months steroid therapy, eosinophilia persisted. Stool examination was performed to rule out intestinal helminth infections. Rhabditoid larvae of Strongyloides stercoralis were detected and the patient was diagnosed as strongyloidiasis. This diagnosis was confirmed again by PCR. The patient was treated with albendazole for 14 days and her abdominal pain and diarrhea improved. This case highlights the need for thorough investigation, including molecular approaches, to test for strongyloidiasis before and during steroid therapies.
Aged ; Albendazole/administration & dosage ; Animals ; Diabetes Mellitus, Type 2/complications ; Eosinophilia/complications/*drug therapy ; Female ; Gastrointestinal Stromal Tumors/complications/*drug therapy ; Humans ; Imatinib Mesylate/*administration & dosage ; Steroids/*administration & dosage ; Strongyloides stercoralis/genetics/isolation & purification/physiology ; Strongyloidiasis/*drug therapy/parasitology

STATEMENT OF PROBLEM: Pier abutments act as a Class I fulcrum lever system when the teeth are incorporated in a fixed partial denture with rigid connectors. Therefore non-rigid connector incorporated into the fixed partial denture might reduce the stresses created by the leverage. PURPOSE: The purpose of this study was to evaluate, by means of finite element method, the effects of non-rigid connectors and supporting alveolar bone level on stress distribution for fixed partial dentures with pier abutments. MATERIAL AND METHODS: A 2-dimensional finite element model simulating a 5-unit metal ceramic fixed partial denture with a pier abutment with rigid or non-rigid designs, the connector was located at the distal region of the second premolar, was developed. In the model, the lower canine, second premolar, and second molar served as abutments. Four types of alveolar bone condition were employed. One was normal bone condition and others were supporting bone reduced 20% height at one abutment. Two different loading conditions, each 150 N on 1st premolar and 1st molar and 300N on 1st molar, were used. RESULTS: Two types of FPD were displaced apically. The amount of displacement decreased in an almost linear slope away from the loaded point. Non-rigid design tended to cause the higher stresses in supporting bone of premolar and molar abutments and the lower stresses in that of canine than rigid design. Alveolar bone loss increased the stresses in supporting bone of corresponding abutment. CONCLUSION: Careful evaluation of the retentive capacity of retainers and the periodontal condition of abutments may be required for the prosthetic design of fixed partial denture with a pier abutment.
Alveolar Bone Loss ; Bicuspid ; Ceramics ; Denture, Partial, Fixed ; Displacement (Psychology) ; Molar ; Tooth

STATEMENT OF PROBLEM: Delamination of veneering porcelain from underlying ceramic substructures has been reported for zirconia-ceramic restorations. Colored zirconia cores for esthetics have been reported that their bond strength with veneered porcelain is weaker compared to white zirconia cores. PURPOSE: This study aimed to investigate the shear bond strength by manufacturing the veneering porcelain on the colored zirconia core, using the layering technique and heat-pressing technique, and to evaluate the clinical stability by comparing the result of this with that of conventional metal ceramic system. MATERIAL AND METHODS: A Metal ceramic (MC) system was tested as a control group. The tested systems were Katana zirconia with CZR (ZB) and Katana Zirconia with NobelRondo Press (ZP). Thirty specimens, 10 for each system and control, were fabricated. Specimen disks, 3 mm high and 12 mm diameter, were fabricated with the lost-wax technique (MC) and the CAD-CAM (ZB and ZP). MC and ZB specimens were prepared using opaque and dentin veneering ceramics, veneered, 3 mm high and 2.8 mm in diameter, over the cores. ZP specimens were prepared using heat pressing ingots, 3 mm high and 2.8mm in diameter. The shear bond strength test was performed in a Shear bond test machine. Load was applied at a cross-head speed of 0.50 mm/min until failure. Mean shear bond strengths (MPa) were analyzed with the One-way ANOVA. After the shear bond test, fracture surfaces were examined by SEM. RESULTS: The mean shear bond strengths (SD) in MPa were MC control 29.14 (2.26); ZB 29.48 (2.30); and ZP 29.51 (2.32). The shear bond strengths of the tested systems were not significantly different (P > .05). All groups presented cohesive and adhesive failures, and showed predominance of cohesive failures in ceramic veneers. CONCLUSION: 1. The shear bond strengths of the tested groups were not significantly different from the control group (P > .05). 2. There was no significant different between the layering technique and the heat pressing technique in the veneering methods on the colored zirconia core. 3. All groups presented cohesive and adhesive failures, and showed predominance of cohesive failures in ceramic veneers.
Adhesives ; Ceramics ; Computer-Aided Design ; Dental Porcelain ; Dentin ; Esthetics ; Hot Temperature ; Humans ; Zirconium