In the case of a soft tissue defect which requires thin & pliable tissues, the choice of donor site is limited due to flap bulkiness and donor site morbidity. To overcome these problems, a variety of perforator-based flaps such as paraspinous and parasacral perforator flap, deep inferior epigastric perforator flap, gluteal perforator flap, and thoracodorsal artery perforator flap have recently been introduced. We experienced 8 cases of soft tissue defects from December 1996 to March 1999 using the thoracodorsal artery perforator flap for reconstruction. We could elevate the cutaneous flap with preservation of the latissimus dorsi muscle flap only when it was based on one cutaneous perforator. Defatting procedure was possible for further thinning of skin flap. In one case, axillary defect after release of postburn scar contracture was repaired with island perforator flap and the other seven cases were repaired with free flap. The results were satisfactory. We believe the thoracodorsal artery perforator flap is useful for reconstruction of soft tissue defects which are large or under conditions requiring thin flap.
Arteries* ; Cicatrix ; Contracture ; Free Tissue Flaps ; Humans ; Perforator Flap ; Skin* ; Superficial Back Muscles ; Tissue Donors

No abstract available.
Vitamin K Deficiency* ; Vitamin K* ; Vitamins*

BACKGROUND: Stunned myocardium may be mediated by intracellular Ca2+ overloading or oxygen derived-free radicals. Halothane and propofol have been shown to block Ca2+ channels. Propofol is also known to have antioxidant properties. The present study was aimed to investigate the effects of anesthetics on recovery of postischemic, reperfused myocardium in open-chest dogs. Incidence of ventricular arrhythmia upon ischemia and reperfusion was also determined. METHODS: Forty dogs were subjected to 15 min occlusion of left anterior descending coronary artery (LAD) followed by 3 hr reperfusion during halothane (n=10), fentanyl (n=12), or propofol plus fentanyl (n=11) anesthesia. Regional contractile function was assessed using percent systolic shortening (%SS), the preload recruitable stroke work slope (Mw), and peak systolic intramyocardial pressure (IMPs). Diastolic function was evaluated using time constant for isovolumic intramyocardial pressure decline of left ventricle (IMP-tau) and percent post-systolic shortening (%PSS). RESULTS: %SS in the halothane, fentanyl, and propofol-fentanyl groups was similar at 3 hours of reperfusion (58%, 60%, and 55% of baseline value, respectively). Moreover, Mw recovered to the baseline values in the early reperfusion period in all three groups. However, IMP-tau was significantly prolonged in the halothane group throughout the 3 hour reperfusion period, whereas it remained unchanged in the fentanyl and propofol-fentanyl groups. Coronary occlusion was associated with 9, 33, and 0% mortality rate due to ventricular fibrillation upon ischemia and reperfusion in the halothane, fentanyl, and propofol-fentanyl groups, respectively. CONCLUSION: These findings indicate that halothane, but not fentanyl and propofol- fentanyl, impairs myocardial relaxation, while recovery pattern of contractile function do not differ among three groups, and that halothane and propofol reduce reperfusion arrhythmia in the canine model of myocardial stunning.
Anesthesia* ; Anesthetics ; Animals ; Arrhythmias, Cardiac ; Coronary Occlusion ; Coronary Vessels ; Dogs* ; Fentanyl* ; Halothane* ; Heart Ventricles ; Incidence ; Ischemia ; Mortality ; Myocardial Stunning* ; Myocardium ; Oxygen ; Propofol ; Relaxation ; Reperfusion ; Stroke ; Ventricular Fibrillation

No abstract available.
Compliance* ; Early Detection of Cancer* ; Family Practice* ; Humans

OBJECTIVE: It has been known that the posterior pedicle screw fixation provides good mechanical stability in unstable burst fracture. But, posterior fixation without anterior column support may not be adequate to withstand the axial load and to keep the corrected kyphotic angle. We present results of one stage fixation by posterior approach in unstable burst fracture. METHODS: Nine patients with unstable burst fracture were treated with posterior fixation and intervertebral fusion using titanium mesh cages and pedicle screws. The canal decompression was achieved by laminectomy and partial pediculectomy through the posterior approach. In all cases, the short segment fixation and anterior column support with cage were performed on the one stage operation. RESULTS: Of nine patients, seven was satisfied with excellent clinical results except two cases of the Frankel's grade A. All patients had good stabilization of spinal column and enough decompression without any neurological complications. It was possible to maintain the corrected kyphotic angle with the circumferential stabilization(three column fixation). CONCLUSION: The anterior and posterior column fixation through the posterior approach provides good stability and decompression in the patients with unstable burst fracture.
Decompression* ; Humans ; Laminectomy ; Spine* ; Titanium

PURPOSE: To analyze the characteristics of defendants, court rulings and the compensation received in medical disputes relating to ophthalmology. METHODS: Retrospective analyses of ophthalmic claims obtained from websites between 1989 and 2014 were performed. RESULTS: Among 42 cases, 26 cases were ruled partially in favor of plaintiffs and 16 cases, ruled in favor of the defendant. Regarding the type of hospital, private clinics accounted for 22 claims, tertiary referral hospitals took 16 claims, and the secondary hospitals took 6 claims. The judgment amount of all of the lawsuits was Won1,770,466,250 and average amount was Won66,743,168 (Won5,000,000-Won455,869,936). The condition with the highest mean payment per claim was glaucoma (Won223,788,608). The consolation money for emotional distress due to violation of liability for explanation comprised a large proportion of the compensation, accounting for 62% of total payment. The conditions most likely to result in payment were those related to the retina, which occurred in 7 cases (70%). The conditions most likely to be appealed to a higher court were those involving oculoplasty (100%). Mismanagement of tests and misdiagnosis occurred in 8 cases (62%), mismanagement of treatment occurred in 3 cases (23%), and mismanagement of anesthesia and recovery occurred in 1 case (9%). CONCLUSIONS: Among all claims, those involving private clinics were most commonly involved (52%) and 62% of all claims were decided partially in favor of plaintiffs. Violation of liability during the explanation of the condition and negligence during the act of diagnosis and treatment were significant reasons for payment. Examination of these cases will help to promote patient safety and reduce repeated medical disputes.
Anesthesia ; Compensation and Redress ; Diagnosis ; Diagnostic Errors ; Dissent and Disputes ; Glaucoma ; Hospitals, Private ; Judgment ; Jurisprudence* ; Korea ; Malpractice ; Ophthalmology* ; Patient Safety ; Retina ; Retrospective Studies ; Tertiary Care Centers

PURPOSE: To analyze the characteristics of defendants, court rulings and the compensation received in medical disputes relating to ophthalmology. METHODS: Retrospective analyses of ophthalmic claims obtained from websites between 1989 and 2014 were performed. RESULTS: Among 42 cases, 26 cases were ruled partially in favor of plaintiffs and 16 cases, ruled in favor of the defendant. Regarding the type of hospital, private clinics accounted for 22 claims, tertiary referral hospitals took 16 claims, and the secondary hospitals took 6 claims. The judgment amount of all of the lawsuits was Won1,770,466,250 and average amount was Won66,743,168 (Won5,000,000-Won455,869,936). The condition with the highest mean payment per claim was glaucoma (Won223,788,608). The consolation money for emotional distress due to violation of liability for explanation comprised a large proportion of the compensation, accounting for 62% of total payment. The conditions most likely to result in payment were those related to the retina, which occurred in 7 cases (70%). The conditions most likely to be appealed to a higher court were those involving oculoplasty (100%). Mismanagement of tests and misdiagnosis occurred in 8 cases (62%), mismanagement of treatment occurred in 3 cases (23%), and mismanagement of anesthesia and recovery occurred in 1 case (9%). CONCLUSIONS: Among all claims, those involving private clinics were most commonly involved (52%) and 62% of all claims were decided partially in favor of plaintiffs. Violation of liability during the explanation of the condition and negligence during the act of diagnosis and treatment were significant reasons for payment. Examination of these cases will help to promote patient safety and reduce repeated medical disputes.
Anesthesia ; Compensation and Redress ; Diagnosis ; Diagnostic Errors ; Dissent and Disputes ; Glaucoma ; Hospitals, Private ; Judgment ; Jurisprudence* ; Korea ; Malpractice ; Ophthalmology* ; Patient Safety ; Retina ; Retrospective Studies ; Tertiary Care Centers