PURPOSE: The recent advances in microsurgical techniques and their refinement over the past decade have greatly expanded the indications for digital replantations and have enabled us to salvage severed fingers more often. Many studies have reported greater than 80% viability rates in replantation surgery with functional results. However, replantation of multi-level amputations still remain a challenging problem and the decision of whether or not to replant an amputated part is difficult even for an experienced reconstructive surgeon because the ultimate functional result is unpredictable. METHODS: Between January of 2002 and May of 2008, we treated 10 multi-level amputated digits of 7 patients. After brachial plexus block, meticulous replantation procedure was performed under microscopic magnification. Postoperatively, hand elevation, heat lamp, drug therapy and hyperbaric oxygen therapy were applied with careful observation of digital circulation. Early rehabilitation protocol was performed for functional improvement. RESULTS: Among the 19 amputated segments of 10 digits, 16 segments survived completely without any complications. Overall survival rate was 84%. Complete necrosis of one finger tip segment and partial necrosis of two distal amputated segments developed and subsequent surgical interventions such as groin flap, local advancement flap and skin graft were performed. The overall result was functionally and aesthetically satisfactory. CONCLUSION: We experienced successful replantations of multi-level amputated digits. When we encounter a multi-level amputation, the key question is whether or not it is a contraindication to replantation. Despite the demand for skillful microsurgical technique and longer operative time, the authors' results prove it is worth attempting replantations in multi-level amputation because of the superiority in aesthetic and functional results.
Amputation ; Brachial Plexus ; Fingers ; Groin ; Hand ; Hot Temperature ; Humans ; Hyperbaric Oxygenation ; Necrosis ; Operative Time ; Replantation ; Skin ; Survival Rate ; Transplants

OBJECTIVES: The aim of this study was to determine the relationship between the intensity of snoring and severity of sleep apnea using Watch-PAT (peripheral arterial tone) 100. METHODS: A total of 404 patients (338 males and 66 females) who underwent home-based portable sleep study using Watch-PAT 100 for obstructive sleep apnea (OSA) from January 2009 through December 2011 were included in this study. Subjects were divided into 4 groups; no OSA (PAT apnea hypopnea index [pAHI]<5/hour), mild OSA (5< or =pAHI<15/hour), moderate OSA (15< or =pAHI<30/hour), or severe OSA groups (pAHI> or =30/hour). Mean snoring intensity and percent sleep time with snoring intensity greater than 40, 50, and 60 dB were measured by Watch-PAT 100. Correlations of these parameters with apnea hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index were assessed. RESULTS: The mean age and body mass index were 46.5+/-14.8 years and 24.7+/-3.4 kg/m2, respectively. Mean AHI and RDI were 16.5+/-15.3/hour and 20.8+/-14.3/hour, respectively. The mean snoring intensity in the no, mild, moderate, and severe OSA groups was 44.0+/-2.7, 45.4+/-6.0, 47.7+/-5.0, and 50.5+/-5.6 dB, respectively (P<0.001). There was a positive correlation between snoring intensity and pAHI or PAT RDI (pRDI) (r=0.391 and r=0.385, respectively, both P<0.001). There was also a positive correlation between percent sleep time with the snoring intensity greater than 50 dB and pAHI or pRDI (r=0.423 and r=0.411, respectively, both P<0.001). CONCLUSION: This study revealed that the intensity of snoring increased with the severity of sleep apnea, which suggests that the loudness of snoring might be an indicator of the severity of OSA.
Apnea ; Body Mass Index ; Humans ; Male ; Oxygen ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring*

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the clinical and radiological outcomes of anterior cervical fusion within Harms cage versus an iliac bone block graft. SUMMARY OF LITERATURE REVIEW: There is no current consensus regarding the optimal material for anterior cervical fusion. MATERIALS AND METHODS: This was a single-center study of 107 patients who either underwent anterior cervical fusion with an iliac bone block graft (n=56; group A) or a cancellous bone graft within the cervical Harms titanium cage (n=51; group B). Anterior plating occurred in all cases. Clinical outcomes and complications were evaluated using Visual Analogue Scale (VAS) scores and Odom's Criteria. Radiological outcomes were evaluated by the height of vertebral bodies, sagittal lordosis, the rate of bony union, and the subsidence of cage. RESULTS: The VAS of donor site pain was significantly higher in group A than in group B at the final follow-up. Sagittal lordosis was increased in both groups, but was significantly higher in group B than group A. The rate of bony union was 95% and 91% for both groups 6 months after surgery and reached 100% for both groups at the final follow-up. In terms of cage subsidence, the highest point of subsidence was at the inferior and posterior aspect of the cage and the average amount of subsidence was approximately 1.3 mm at final follow-up. CONCLUSIONS: Anterior cervical fusion using a cancellous bone graft within Harms titanium cage is a good method for anterior cervical fusion with iliac bone block.
Animals ; Consensus ; Follow-Up Studies ; Humans ; Lordosis ; Retrospective Studies ; Tissue Donors ; Titanium ; Transplants

No abstract available.
Peripheral Nervous System Diseases* ; Scleroderma, Systemic*

The hereditary sensory neuropathy is a very rare disease characterized by prominent sensory loss without corresponding motor involvement, but may be associated with autonomic features. Currently, the disease is divided into five main types and most frequent are Type I and Type II. The type II hereditary sensory neuropathy is characterized by autosomal recessive inheritance, onset in utero or in infancy, loss of touch-pressure sense more than paintemperature sense, and almost total absence of myelinated nerve fibers. In this case, we describe a 23 years old female patient with acroosteolysis and heel ulcer who was diagnosed as hereditary sensory neuropathy type II.
Acro-Osteolysis* ; Female ; Heel ; Hereditary Sensory and Autonomic Neuropathies* ; Humans ; Nerve Fibers, Myelinated ; Rare Diseases ; Ulcer ; Wills ; Young Adult

Cells consistently face stressful conditions, which cause them to modulate a variety of intracellular processes and adapt to these environmental changes via regulation of gene expression. Hyperosmotic and oxidative stresses are significant stressors that induce cellular damage, and finally cell death. In this study, oligonucleotide microarrays were employed to investigate mRNA level changes in cells exposed to hyperosmotic or oxidative conditions. In addition, since heat shock protein 70 (HSP70) is one of the most inducible stress proteins and plays pivotal role to protect cells against stressful condition, we performed microarray analysis in HSP70 overexpressing cells to identify the genes expressed in a HSP70 dependent manner. Under hyperosmotic or oxidative stress conditions, a variety of genes showed altered expression. Down regulation of protein phosphatase1 beta (PP1 beta) and sphingosine 1 phosphate phosphatase 1 (SPPase1) was detected in both stress conditions. Microarray analysis of HSP70 overexpressing cells demonstrated that diverse mRNA species depend on the level of cellular HSP70. Genes encoding lysyl oxidase, thrombospondin 1, and procollagen displayed altered expression in all tested conditions. The results of this study will be useful to construct networks of stress response genes.
Cell Death ; Down-Regulation ; Gene Expression Regulation ; Gene Expression* ; Heat-Shock Proteins ; HSP70 Heat-Shock Proteins ; Microarray Analysis ; Oligonucleotide Array Sequence Analysis ; Oxidative Stress* ; Procollagen ; Protein-Lysine 6-Oxidase ; RNA, Messenger ; Sphingosine ; Thrombospondin 1

In the management of the traumatized gravid and her fetus, diagnostic tests and therapy should be directed primarily at the care of the mother and should not be delayed or compromised because of the pregnancy. Because many factors can damage when the mother is unconscious, fetal well-being should be assessed by serial biophysical profile scoring. If the mother's condition is stable as in the chronic vegetative state, elective delivery might best be performed at a gestational age of 32 to 34 weeks.
Diagnostic Tests, Routine ; Fetus ; Gestational Age ; Humans ; Mothers ; Persistent Vegetative State* ; Pregnancy*

Trastuzumab (Herceptin), a humanized monoclonal antibody, is a cancer drug developed to target the human epidermal receptor (HER) 2, which is overexpressed in some cancer cells. Cutaneous side effects, such as folliculitis, xerosis, and alopecia have not been reported with therapies targeting HER2, in spite of the frequent observances of such with the therapies targeting the epidermal growth factor receptor. We experienced a patient in whom psoriasis was triggered by the trastuzumab treatment for breast cancer. She was a 57-year-old woman with erythematous and scaly plaques occurring a few months after starting trastuzumab, with repeated aggravation after the re-administration of trastuzumab for the breast cancer. Histologic examination showed the typical features of psoriasis with parakeratosis, epidermal hyperplasia, elongation of the rete ridges, and a lymphocytic and polymorphonuclear cell infiltrate in the dermis. To the best of our knowledge, this is the first report of psoriasis triggered by trastuzumab treatment for breast cancer.
Alopecia ; Antibodies, Monoclonal, Humanized ; Breast Neoplasms ; Dermis ; Female ; Folliculitis ; Humans ; Hyperplasia ; Parakeratosis ; Psoriasis ; Receptor, Epidermal Growth Factor ; Trastuzumab

Simultaneous or subsequent bilateral thalamic hemorrhagic events have ranged from 12 to 19 in prior reports, with a time lag between bilateral thalamic hemorrhage of up to two days. Herein, we report the first case of delayed (17 days) consecutive contralateral thalamic hemorrhage after spontaneous first thalamic hemorrhage. A 65-year-old female initially presented with a drowsy mentality with a left-side motor weakness (grade II/III). Brain computed tomography (CT) demonstrated right side thalamic and intraventricular hemorrhage. She regained alertness with mild residual motor weakness (grade III/IV) under medical management. Seventeen days later, a sudden and generalized tonic-clonic seizure developed. Brain CT scans revealed a new contralateral thalamic hemorrhage coincident with microbleeds. Neurologic status remained unchanged, consisting of a stuporous mentality with quadriparesis of grade II/II. We report the first case of delayed consecutive contralateral thalamic hemorrhage up to 17 days after first thalamic hemorrhage. The case highlights the need for close monitoring of patients with thalamic hemorrhage who experience microbleeds on the contralateral side, due to the possibility of delayed hemorrhage.
Aged ; Brain ; Female ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Hemorrhages ; Quadriplegia ; Seizures ; Stupor ; Thalamus ; Tomography, X-Ray Computed

Simultaneous or subsequent bilateral thalamic hemorrhagic events have ranged from 12 to 19 in prior reports, with a time lag between bilateral thalamic hemorrhage of up to two days. Herein, we report the first case of delayed (17 days) consecutive contralateral thalamic hemorrhage after spontaneous first thalamic hemorrhage. A 65-year-old female initially presented with a drowsy mentality with a left-side motor weakness (grade II/III). Brain computed tomography (CT) demonstrated right side thalamic and intraventricular hemorrhage. She regained alertness with mild residual motor weakness (grade III/IV) under medical management. Seventeen days later, a sudden and generalized tonic-clonic seizure developed. Brain CT scans revealed a new contralateral thalamic hemorrhage coincident with microbleeds. Neurologic status remained unchanged, consisting of a stuporous mentality with quadriparesis of grade II/II. We report the first case of delayed consecutive contralateral thalamic hemorrhage up to 17 days after first thalamic hemorrhage. The case highlights the need for close monitoring of patients with thalamic hemorrhage who experience microbleeds on the contralateral side, due to the possibility of delayed hemorrhage.
Aged ; Brain ; Female ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Hemorrhages ; Quadriplegia ; Seizures ; Stupor ; Thalamus ; Tomography, X-Ray Computed