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

No abstract available.

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.

PURPOSE: To analyze pre- and post-operative factors associated with favorable long-term sensory outcome after surgical correction for infantile esotropia. METHODS: This study retrospectively examined 40 patients with infantile esotropia who underwent surgery from January 2000 to December 2010. Clinical characteristics analyzed included age at onset, age at surgery, mean preoperative deviation, amblyopia on initial visit, other associated strabismus (Inferior oblique overaction (IOOA), dissociated vertical deviation (DVD), latent nystagmus), initial and subsequent postoperative motor alignment at 1-week and 2-year follow-up, recurrence rate, and stereopsis. Long-term sensory outcome was categorized as favorable (< or =400 arcsec) or unfavorable (>400 arcsec). RESULTS: The mean follow-up period was 92.53 +/- 46.46 months. There were 19 patients (47.5%) in the favorable group and 21 (52.5%) in the unfavorable group. There were no statistically significant differences between the groups with respect to age at onset or surgery, presence of amblyopia, and prevalence of IOOA and DVD, latent nystagmus, or initial postoperative alignment at 1-week. There was a tendency towards worse binocularity with larger preoperative angles of esodeviation, but it was not significant. Binocularity was significantly higher among those who had surgery at age < or =24 months than at age >24 months. Orthotropic alignment within +/-10 PD at 2-year follow-up was 68.4% in the favorable group and 38.1% in the unfavorable group. Reoperation was performed on 8 patients (38.1%) in the unfavorable group and no patients (0.0%) in the favorable group. CONCLUSIONS: Surgical correction of infantile esotropia within the first 2 years of life and maintenance of orthotropic alignment within +/-10 PD without additional surgery with a minimum follow-up of 2 years may be associated with favorable long-term sensory outcome in infantile esotropia.
Amblyopia ; Depth Perception ; Esotropia* ; Follow-Up Studies ; Humans ; Prevalence ; Recurrence ; Reoperation ; Retrospective Studies ; Strabismus ; Telescopes

Purpose: To evaluate the efficacy of terazosin in chronic pelvic pain syndrome (CPPS) and compare the effect of terazosin between CPPS IIIa and IIIb. Materials end Methods: Between January 2004 and February 2005, CPPS patients, aged 45 or below, with a small size prostate (0.05). In category IIIb (n=56), the T group (n=29) showed significant improvements in all NIH-CPSI domains and the Qmax (p<0.05), but the non-T group (n=27) showed no significant improvement in the NIH-CPSI domains or the Qmax (p>0.05). Comparing both category IIIb groups, the T group showed a greater improvement in the pain score in the NIH-CPSI domains and the Qmax than the non-T group. Conclusions: Terazosin was effective in all domains of the symptom score and in the Qmax for CPPS.
Humans ; Massage ; Pelvic Pain* ; Prostate ; Prostatitis ; Quality of Life ; Ultrasonography ; Urinalysis

No abstract available.
Amyloidosis* ; Humans ; Kidney Failure, Chronic* ; Skin*

No abstract available.
Lipomatosis*

PURPOSE: To evaluate the usefullness of repeated alcohol sclerotherapy for two days through the percutaneous catheter in the treatment of renal cyst. MATERIALS AND METHODS: Repeated sclerotherapies using absolute ethanol(99.9%) were parformed on 20 renal cysts in 18 patients through the indwelling catheter. The cyst volume ranged from 50 ml to 1000ml(mean, 300ml). Under the ultrasound- or CT-guidance, 6F catheter was inserted into the cyst percutaneously. After aspirating the fluid in the cyst, absolute ethanol was injected. While maintaining the catheter for 16-20 hours, at least 3 times of sclerotherapies performed with total procedure time of 30-60 minutes. Follow-up sonography was performed to evaluate the recurrence or collapse of the cysts at 1 and 3 months after the procedure. RESULTS: Among 20 renal cysts, 2 cases were recurred on 1 month follow-up sonography(10%). However, the volumes of recurred cysts were decreased to 40% and 10%, respectively. There was no immediate or delayed complication after sclerotherapy. DISCUSSION: Repeated sclerotherapy for 2 days using absolute ethanol through the percutaneous catheter insertion is a useful method of treatment for renal cyst.
Catheters* ; Catheters, Indwelling ; Ethanol ; Follow-Up Studies ; Humans ; Recurrence ; Sclerotherapy*