No abstract available.

Reconstruction of extensive soft tissue defects of the lower extremity, especially when complicated by open fracture and bone loss, is usually a difficult problem for the plastic surgeon. Many methods have been devised to treat these conditions Musculocutaneous flaps add a valuable surgical alternative that bring vascularized cover to the defects, and the free microvascular transfer of these flaps gives the surgeon an added dimension of versatility. The latissimus dorsi is an extremly reliable musculocutaneous flap with a long, large-caliber vascular pedicle, so that dissection of the muscle can be performed with relative ease. The size of the latissimus dorsi muscle lends itself to coverage of large defects. While these characteristics appear to make the free latissimus dorsi musculocutaneous transfer ideal in many circumstances, it has some disadvantages. At the recipient site, the flap is ofter too bulky, and donor-site closure requires skin grafts if the flap is wider than 10cm. These skin grafts on the posterior thorax seriously detract from the final appearance of the donor site. The authors have experienced 12 cases of reconstruction of extensive lower extremity soft tissue defect in which the latissimus dorsi muscle alone was transferred and covered with a split-thickness skin graft. This method improves the recipient-site contour by decreasing the bulk of the flap and it also improves the donor-site appearance. We described technical considerations in each case and the advantages of free latissimus dorsi muscle flap and skin graft for the reconstruction of extensive soft tissue defect in the lower extremity.
Fractures, Open ; Humans ; Lower Extremity ; Myocutaneous Flap ; Skin ; Superficial Back Muscles* ; Thorax ; Tissue Donors ; Transplants

Glomus tumor is well recognized and documented lesion which usually presents as painful dermal nodules in fingers. The tumor results from hypertrophy of a glomus, which is a normal structure of the skin, a coiled arterioyenous shunt regulating body temperature. Glomus tumor may occur at any age but is most frequent in the middle age of life. Pain, tenderness and cold sensitivity are the classic triad of symptoms. Complete surgical exision is the treatment of choice for glomus tumors. Successful removal of tumor leads to complete relief of pain and return to normal function. We report 4 cases of subungual glomus tumor successfully treated by complete exision with review of literatures.
Body Temperature ; Fingers ; Glomus Tumor ; Humans ; Hypertrophy ; Middle Aged ; Skin

BACKGROUND: It has been known that arterial carbon dioxide tension is 4~5 mmHg higher than end-tidal carbon dioxide tension in healthy adults during general anesthesia. But negative arterial to end-tidal PCO2 difference was reported in pregnant patients undergoing cesarean section. The purpose of this study was to elucidate the difference between arterial and end-tidal PCO2 in anesthetized patients with reduced functional residual capacity. METHODS: 90 patients were divided into 3 groups i.e. control group (n=30), obese group (n=20, body weight more than 20% greater than ideal weight), pregnant group (n=40). All patients had no cardiac or respiratory abnormalities and never smoked. Arterial blood gas analysis and measurement of end-tidal PCO2 were done 20 minutes after induction of anesthesia in control and obese group and just before uterine incision and 20 minutes after fetal delivery in pregnant group. RESULTS: There were significant correlations between arterial and end-tidal PCO2 in all groups. The incidences of negative arterial to end-tidal PCO2 difference were 10% in control group, 40% in obese group, 42.5% in pregnant group (p<0.05). CONCLUSION: From this study, it is concluded that patients with reduced functional residual capacity have more incidences of negativity than normal patients in the values of arterial to end-tidal PCO2 difference during general anesthesia. So when the tight control of PaCO2 is required in patients with reduced FRC, we recommend to measure PaCO2 for better anesthetic management.
Adult ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Body Weight ; Carbon Dioxide* ; Carbon* ; Cesarean Section ; Female ; Functional Residual Capacity* ; Humans ; Incidence ; Pregnancy ; Smoke

Objectives: Cheyne-Stokes respiration (CSR) is frequently found in critically ill patients and is associated with poor prognosis. However, CSR has not been evaluated in neurocritical patients. This study investigated the frequency and prognostic impact of CSR in neurocritical patients using biosignal big data obtained from intensive care units. Methods: This study included all patients who received neurocritical care at the tertiary hospital from January 2018 to December 2019. Clinical information and biosignal data of intensive care units were used and analyzed. The respiratory curve was visually assessed to determine whether CSR and obstructive sleep apnea (OSA) were present, and a heart rate variability (HRV) was obtained from the electrocardiogram. Results: CSR was confirmed in 166 of 406 patients (40.9%). Patients with CSR were older, had a higher frequency of cardiovascular risk factors as well as heart failure, and had a poor outcome (modified Rankin scale ≥4). As a result of multiple regression analysis adjusted for other variables, CSR was significantly associated with poor outcome with an odds ratio of 2.27 times higher (95% confidence interval 1.25–4.14, p=0.007). HRV analysis demonstrated that CSR and OSA had distinct autonomic characteristics. Conclusions This study first revealed the substantial frequency of CSR in neurocritical patients and suggests that it can be used as a predictor of poor prognosis in neurocritical care.

Fetal bilateral renal agenesis is a lethal congenital anomaly. An early and reliable prenatal diagnosis is extremely important as it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, and the empty renal fossa. However, severe oligohydramnios makes it difficult to diagnose the disease because of poor sonographic resolution. We present two cases of bilateral renal agenesis, one is diagnosed by ultrasonography after amnioinfusion at 24 weeks gestation, the other is diagnosed postnatally after term delivery.
Diagnosis ; Female ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Ultrasonography ; Urinary Bladder

No abstract available.
Child ; Child Development* ; Humans ; Infant* ; Mass Screening*

No abstract available.
Hyperaldosteronism*

Cerebral infarction in the territory of the paramedian thalamopeduncular artery (PTA) causes various lesions in the upper midbrain and thalamus resulting in widespread disturbances in neurological function. However, the exact topography and variations in the territories of the PTA remain unknown. We report four patients with MRI-proven infarctions in the PTA territory. One patient had lesions in the unilateral thalamus and midbrain, the other two had lesions in the bilateral paramedian thalamus and unilateral midbrain, and the remaining patient had lesions in the unilateral thalamus and bilateral midbrain. Clinical manifestations depended on the variations of the size and extent of infarctions. Theanatomical variations of the PTA are discussed and suggested.
Arteries* ; Cerebral Infarction ; Humans ; Infarction* ; Mesencephalon ; Thalamus

Cryptosporidium parvum oocysts were isolated from a child suffering from acute gastroenteritis and successfully passaged in a calf and mice (designated hereafter SNU-H1) in the Republic of Korea; its molecular genotype has been analyzed. The GAG microsatellite region was amplified by a polymerase chain reaction (PCR), with a 238 base pair product, which is commonly displayed in C. parvum. The isolate was shown to be a mixture of the genotypes 1 (anthroponotic) and 2 (zoonotic). To study its infectivity in animals, 2 calves and 3 strains of mice were infected with the SNU-H1; in these animals, the propagation of both genotypes was successful. In immunosuppressed (ImSP) BALB/c and C57BL/6 mice the number of oocysts decreased after day 10 post-infection (PI) ; but in ImSP ICR mice, they remained constant until day 27 PI. The results show that both the C. parvum genotypes 1 and 2 can be propagated in calves and ImSP mice.
Animals ; Cattle ; Child ; Cryptosporidiosis/microbiology ; Cryptosporidium parvum/*genetics/immunology ; Diarrhea/parasitology ; Feces/parasitology ; Genotype ; Human ; Korea ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Mice, Inbred ICR ; Oocysts ; Polymerase Chain Reaction ; Support, Non-U.S. Gov't ; Zoonoses/parasitology