We have evaluated the clinical results following the 46 cases of free vascularized osteocutaneous fibular flap transfer to the tibial defect combined with soft tissue defect, which were performed from May 1982 to January 1997. In the 46 consecutive procedures of free vascularized osteocutaneous fibular flap transfer, initial bony union were obtained in the 43 grafted fibulars at average 3.75 months after operation. There were 2 cases in delayed unions and 1 in nonunion. 44 cutaneous flaps among the 46 cases were survived but 2 cases were necrotized due to deep infection and venous insufficiency. One necrotized flap was treated with latissimus dorsi free flap transfer and the other was treated with soleus muscle rotational flap. Grafted fibulas have been hypertrophied during the follow-up periods. The fracture of grafted fibula (15 cases) was the most common complication and occurred at average 9,7 months after the operation. The fractured fibulas were treated with the cast immobilization or internal fixation with conventional cancellous bone graft. In the cases of tibia and fibula fracture at recipient site, the initial rigid fixation for the fibula fracture at recipient site could prevent the fracture of grafted fibula to the tibia.
Fibula ; Follow-Up Studies ; Free Tissue Flaps ; Immobilization ; Muscle, Skeletal ; Superficial Back Muscles ; Tibia* ; Transplants* ; Venous Insufficiency

OBJECTIVES: Sleep disturbance constitutes a significant and relatively common source of suffering for cancer patients. It is a challenge for oncologists to address this troubling symptom with pharmacotherapy's limited evidence base. This paper systematically reviewed the literature for evidence of pharmacological treatment of sleep disturbances in this population. METHODS: We searched international and domestic databases using the search terms "cancer", "sleep disturbance", and "pharmacological intervention", limiting the search to English- and Korean-language articles published between 1980 and 2008. Included studies were intervention studies, systematic reviews, and meta-analyses on pharmacological treatment for the sleep disturbance of adult patients suffering various medical conditions, including cancer. We graded the included studies according to Scottish Intercollegiate Guideline Network (SIGN) methodology checklists. RESULTS: Of the 223 studies searched, we only 7 studies met the criteria : 1 systematic review and 6 (85.7%) intervention studies. Among currently prescribed medications for sleep disturbance, only a few have been studied in patients with cancer, and their long-term follow-up data was not available. CONCLUSION: Based on available literature, the evidence in favor of pharmacological treatment for sleep disturbance (in cancer patients) is weak. Further studies containing long-term follow-up data should be conducted.
Adult ; Checklist ; Humans ; Clinical Trial ; Stress, Psychological

BACKGROUND: Few studies have examined the association between mercury exposure and obesity. The aim of this study is to investigate the association between blood mercury concentrations and indices of obesity in adults. METHODS: A total of 200 healthy subjects, aged 30 to 64 years, who had no history of cardiovascular or malignant disease, were examined. Anthropometric and various biochemical profiles were measured. Visceral adipose tissue (VAT) was measured using dual-energy X-ray absorptiometry (DXA). RESULTS: All subjects were divided into three groups according to blood mercury concentrations. Compared with the subjects in the lowest tertile of mercury, those in the highest tertile were more likely to be male; were current alcohol drinkers and smokers; had a higher body mass index (BMI), waist circumference (WC), and VAT; had higher levels of blood pressure, fasting glucose, and insulin resistance; and consumed more fish. The blood mercury concentration was significantly associated with anthropometric parameters, showing relationships with BMI, WC, and VAT. After adjusting for multiple risk factors, the odds ratios (ORs) for high mercury concentration was significantly higher in the highest VAT tertile than in the lowest VAT tertile (OR, 2.66; 95% confidence interval, 1.05 to 6.62; P<0.05). CONCLUSION: The blood mercury concentration was significantly associated with VAT in healthy adults. Further studies are warranted to confirm our findings.
Absorptiometry, Photon ; Adiposity* ; Adult* ; Blood Pressure ; Body Mass Index ; Fasting ; Glucose ; Healthy Volunteers ; Humans ; Insulin Resistance ; Intra-Abdominal Fat ; Male ; Obesity ; Odds Ratio ; Risk Factors ; Waist Circumference

No abstract available.
Hysterectomy*

A 22 year old male with hemophilia B was scheduled for the correction of a right subtrochanteric femur fracture. Plasma concentration of coagulation factor IX in this patient was 50% of the normal level and the partial thromboplastin time was 57 seconds on the first day of hospital administration. We started the intravenous administration of facnyne injection (factor IX) 11 days before the operation when his plasma concentration was 20%. His plasma concentration was 40% on the operation day. The operation and general anesthesia were accomplished safely without severe hemorrhage or major complication. He received facnyne injection continuously until the 5th postoperative day: 25-43% of his plasma concentrations of factor IX was maintained. He had no problem with postoperative care.
Administration, Intravenous ; Anesthesia, General ; Factor IX ; Femur ; Hemophilia A* ; Hemophilia B* ; Hemorrhage ; Hospital Administration ; Humans ; Male ; Partial Thromboplastin Time ; Plasma ; Postoperative Care ; Young Adult

PURPOSE: To study the development of inferior shoulder subluxation after surgery for proximal humerus fractures. To analyze the mechanism development of such subluxation and the association between different types of proximal humerus fractures, quality of reduction achieved the method of operation performed. MATERIALS AND METHODS: A retrospective analysis of 45 proximal humerus fractures that were treated by surgery between March 1997 and July 2002 was done. All patients had a minimum of 12 months of postoperative follow up. Preoperative radiographs were classified by the Neer's classification. Different operative treatment methods, post reduction alignment and the degree of postoperative subluxation if present, were analysed. In order to evaluate effect of loss of negative intraarticular pressure, we compared this series with 15 cases of recurrent shoulder dislocation treated by open Bankart operation. RESULTS: 13 patients out of 45 (29%) developed immediate postoperative inferior shoulder subluxation. 3-part fractures of the proximal humerus showed a higher incidence of the same than the 2-part types. The better reduced fractures had lesser rates of subluxation. Open reduction (39%, 11 patients) results in an increased incidence of inferior subluxation than closed methods of reduction (13%, 2 patients). CONCLUSION: Inferior subluxation of the humeral head after surgery for the proximal humerus fracture can occur and persist till postoperative period of 2 months. Deltoid muscle tone affected by shortening of humeral neck plays an important role. Early active exercise for restoration deltoid tone may be effective in prevention of inferior subluxation.
Classification ; Deltoid Muscle ; Follow-Up Studies ; Head* ; Humans ; Humeral Head ; Humerus* ; Incidence ; Neck ; Postoperative Period ; Retrospective Studies ; Shoulder ; Shoulder Dislocation

The coronavirus disease 2019 (COVID-19) has been a major public health emergency worldwide. Vaccines were rapidly developed and approved to prevent the spread of viral infection. However, various side effects of the COVID-19 messenger RNA (mRNA) vaccines have been reported after their commercialization. A 24-year-old man visited our emergency department with polyuria and polydipsia that occurred after he received a COVID-19 mRNA vaccine 10 days beforehand. The initial laboratory findings showed very low urine osmolality with hyperosmolar hypernatremia. Based on these findings, diabetes insipidus was suspected, and sella magnetic resonance imaging showed an enlarged pituitary gland and the absence of posterior pituitary higher intensity. After 12 hours of using oral desmopressin acetate, urine volume decreased, and after 5 days of administration, serum electrolyte and serum osmolality improved. This case report of diabetes insipidus occurring after vaccination with the BNT162b2 mRNA COVID-19 vaccine is presented as a reminder that close monitoring is necessary for patients with polyuria and polydipsia after vaccination.

Background: To examine whether glycated hemoglobin (HbA1c) test would be a suitable screening tool for detecting high-risk subjects for diabetes compared to oral glucose tolerance test (OGTT) according to accompanied central obesity. Methods: In this prospective population-based cohort study, both OGTT and HbA1c tests were performed and continued every 2 years up to 12 years among individuals with non-diabetic state at baseline (aged 40 to 69 years, n=7,512). Incident diabetes was established by a doctor, HbA1c ≥6.5%, and/or fasting plasma glucose (FPG) ≥126 mg/dL, and/or 2-hour postprandial glucose (2hPG) level based on OGTT ≥200 mg/dL. Discriminative capacities of high HbA1c (≥5.7%) versus high 2hPG (≥140 mg/dL) for predicting incident diabetes were compared using Cox-proportional hazard regression and C-index. Results: During the median 11.5 years of follow-up period, 1,341 (17.6%) developed diabetes corresponding to an incidence of 22.1 per 1,000 person-years. Isolated high 2hPG was associated with higher risk for incident diabetes (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.56 to 5.17) than isolated high HbA1c (HR, 2.79; 95% CI, 2.40 to 3.26; P<0.05). In addition, high 2hPG provided better discriminatory capacity than high HbA1c (C-index 0.79 vs. 0.75, P<0.05). Meanwhile, in subjects with central obesity, the HR (3.95 [95% CI, 3.01 to 5.18] vs. 2.82 [95% CI, 2.30 to 3.46]) and discriminatory capacity of incident diabetes (C-index 0.75 vs. 0.75) between two subgroups became comparable. Conclusion Even though the overall inferior predictive capacity of HbA1c test than OGTT, HbA1c test might plays a complementary role in identifying high risk for diabetes especially in subjects with central obesity with increased sensitivity.

The idiopathic calcinosis of the scrotum is multiple and asymptomatic nodules of scrotal skin which can onset either in childhood or early adulthood. It increases in size and number, while breakingdown to discharge chalky contents on occasions. We report a case of a 68-year-old-man who was effectively treated with a simple excision of the affected skin with an idiopathic scrotal calcinosis. There is no family history of scrotal calcification. Histopathologically, multiple nodules showed the epidermal cyst with partially degenerated wall and calcium deposits with a foreign body reaction in the dermis in this case. In most reported cases, some intact epidermal cysts are also present, and dystrophic calcification, and possible inflammation and rupture of epidermal cysts regarded as be the main pathogenetic mechanism of the disease.
Calcinosis* ; Calcium ; Dermis ; Epidermal Cyst ; Foreign-Body Reaction ; Humans ; Inflammation ; Rupture ; Scrotum* ; Skin

PURPOSE: Labral lesions and its anatomic variants have been studied by several authors in the last decade. Buford complex and sublabral recess are most common variants. Their recognition is important in order to distinguish them from superior and anterior labral tear. MATERIALS AND METHODS: We report one case of a 19-year-old female who was mistaken SLAP lesion for normal variant and was treated with arthroscopic surgery. RESULTS: The arthroscopic finding shows rare normal variant of biceps anchor and superior labrum. The biceps long head tendon was inserted at superior labrum and supraspinatus tendon area. This finding was mistaken to SLAP lesion. CONCLUSION: We report rare normal variant of biceps anchor and superior labrum that was observed during arthroscopic surgery for SLAP lesion.
Arthroscopy ; Female ; Head ; Humans ; Shoulder Joint ; Tendons ; Young Adult