The reconstruction of foot remains difficult problem with many surgical modalities because foot has unique structure, insufficient local soft tissue and poor vascularity. The medial plantar island flap is capable of providing sensate and structurally similar tissue with single operative procedure. We reconstructed 5 cases of soft tissue defects on the foot by using medial plantar island flap(3 cases proximally- based, 2 cases distally-based) in diabetics. Successful soft tissue coverage was achieved on medial malleolus, dorsal midfoot, tendo calcaneus, and forefoot. The size of flap ranged from 3.5 x 3.0 cm to 6.0 x 4.0 cm. Follow-up ranged from 8 months to 26 months. All flaps survived without serious complication. All patients had protective sensation in daily activities and were able to ambulate in normal footwear. This paper demonstrates that medial plantar island flap with proximally and distally-based pedicle should be considered as a useful technique for reconstruction of soft tissue defect from ankle to forefoot.
Ankle ; Calcaneus ; Follow-Up Studies ; Foot ; Humans ; Sensation ; Surgical Procedures, Operative

The reconstruction of foot remains difficult due to its unique structure, insufficient local soft tissue and poor vascularity in spite of many surgical modalities. The medial plantar island flap enables to obtain sensate and structurally similar tissue with single operative procedure. We reconstructed 5 cases of soft tissue defects on foot by using medial plantar island flap(3 cases proximally- based, 2 cases distally-based) in diabetics. Successful soft tissue coverage was achieved on medial malleolus, dorsal midfoot, tendo calcaneus, and forefoot. The size of the flap ranged from 3.5 x 3.0 cm to 6.0 x 4.0 cm. The follow-up period ranged from 8 to 26 months. All flaps survived without serious complications. All patients gained confidence in daily activities and were able to ambulate in normal footwear. This paper demonstrates that medial plantar island flap with proximally and distally-based pedicle should be considered as a useful technique for reconstruction of soft tissue defect from ankle to forefoot.
Ankle ; Calcaneus ; Follow-Up Studies ; Foot ; Humans ; Leg* ; Surgical Procedures, Operative

OBJECTIVE: Preterm labor and delivery is probably the largest problem in modern perinatology. The early diagnosis of preterm labor is crucial for prevention of preterm birth. To predict the onset of preterm labor, we examined the diagnostic performance of serial cervical assessment by transvaginal sonography. METHODS: In this prospective study, we performed transvaginal sonography at approximately 30 and 34 weeks of gestation in women with singleton pregnancies. Cervical parameters evaluated included endocervical length, the presence of funneling, funnel length and funnel width. We then assessed the relation between cervical parameters and the risk of spontaneous preterm labor. RESULTS: We examined 258 women at approximately 30 weeks of gestation and 247 of these women again at approximately 34 weeks. Spontaneous preterm labor occurred in 9 of women examined at 30 weeks(Group 1) and in 13 at 34 weeks(Group 2). The endocervical length was normally distributed at 30 and 34 weeks(mean +/-SD, 38.26+/-6.82mm and 35.63+/-7.35mm, respectively). The endocervical length decreased significantly from 30weeks to 34 weeks(p=0.0001). Both groups showed significantly shorter endocervical length(p <0.05) and groupl more presence of funneling than group of term pregnancy(p<0.05). Receiver-operator characteristic curve and multiple logistic regression analyses indicated that endocervical length <-30mm at 30 weeks and <-25mm at 34 showed highest diagnostic index in predicting the onset of preterm labor(p=0.0001). Conclusions: Serial transvaginal ultrasound assessment of endocervical length during early third trimester is a useful predictor of preterm labor and delivery in low-risk patients.
Early Diagnosis ; Female ; Humans ; Logistic Models ; Obstetric Labor, Premature* ; Perinatology ; Pregnancy ; Pregnancy Trimester, Third ; Premature Birth ; Prospective Studies ; Ultrasonography

PURPOSE:The purpose of this study is to evaluate the change of pancreatic size after gastric resection in patients with gastric malignancy. MATERIALS AND METHODS: We compared the pancreatic sizes on pre- and post-operative abdominal CT scans in 50 patients whose stomach had been resected due to malignancy. The mean interval was 20.3 months (range, 5-81 months). The types of the operation were total gastrectomy with esophagojejunostomy and jejunojejunostomy (n=7), and subtotal gastrectomy with gastrojejunostomy (Billroth II) (n=43). Pancreatic thickness was measured perpendicular to the pancreatic long axis at head, body and tail. RESULT: There was a significant reduction of pancreatic size on postoperative CT scan. The reduction rate was 5.9% in the head (p<0.001), 7.1% in the body (p<0.001) and 14.4% in the tail (p<0.001). CONCLUSION:Significant reduction of pancreatic size was observed after gastric resection due to gastric rnalignancy, especially in tail.
Axis, Cervical Vertebra ; Gastrectomy ; Gastric Bypass ; Head ; Humans ; Stomach ; Tomography, X-Ray Computed

PURPOSE: To evaluate the usefulness of MR urography(MRU) using Half-Fourier acquisition single-shot turbospin-echo(HASTE) sequence compared with conventional intravenous urography(IVU). MATERIALS AND METHODS: Thirtyfive lesions of 32 patients who underwent MRU because of delayed excretion or nonvisualization of the ureter wereincluded in this study. HASTE MR urography was performed with a 1.0 MR imaging unit. Coronal images includingthose of the kidney, ureter and bladder were obtained in every patient using the multislice technique, and werepostprocessed by means of the maximal intensity projection technique. Scan time was 17-19 seconds. We analyzed theresults of MRU, focusing on level of obstruction, incidence of stone, ureter dilatation, and motion artifact, andin each case compared MRU findings with those of IVU. RESULTS: In 12 of 35 lesions(34.2%), MRU more effectivelydiagnosed causes of obstruction than did IVU, while in seven lesions(20%), MRU and IVU were similar. In eightlesions(22.9%), all of which were caused by a stone, IVU was better than MRU, and in a further eight, neithermodality was able to diagnose the cause. For diagnosis of the level of obstruction, MRU was better than IVU in 20of 35 lesions(57.1%), and similar to IVU in seven(20%). In three lesions(8.6%), neither modality was able todetect the level of obstruction. Four lesions not related to obstruction were polycystic renal disease, cysticrenal change, vesicovaginal fistula and extra-renal pelvis. Dilatation of the ureter was seen in 23lesions(65.8%) on MRU and in seven lesions on IVU. Thus, MRU revealed dilatation of for the ureter more efectivelythan IVU. CONCLUSION: MRU using HASTE was valuable for the detection of underlying causes and levels ofobstruction in the urinary tract, and of abnormalities in surrounding structures in patients with non-visualization of the kidney or delayed contrast excretion of the ureter, as seen on delayed IVU urogram.
Artifacts ; Diagnosis ; Dilatation ; Humans ; Hydronephrosis ; Incidence ; Kidney ; Magnetic Resonance Imaging ; Pelvis ; Polycystic Kidney Diseases ; Ureter ; Urinary Bladder ; Urinary Tract ; Urography* ; Vesicovaginal Fistula

A 70-year-old female presented with progressive gait disturbance. Neurologic examination revealed sensory impairment, hyporeflexia, and sensory ataxia. Nerve conduction study demonstrated mildly decreased velocity in motor nerves. Brain magnetic resonance imaging showed high signal intensities in the corticomedullary junction on diffusion weighted imaging. Neurocognitive function test implied mild cognitive impairment. Based on eosinophilic intranuclear inclusions in pathology, neuronal intranuclear inclusion disease was confirmed. Neuronal intranuclear inclusion needs to be considered when abnormal nerve conduction studies are consistent with abnormal brain imaging findings.

OBJECTIVE: We observed patients in whom the fluid collection in the right lateral portion of the superior aortic recess on computed tomography (CT) scans mimicked a right anterior mediastinal mass on chest PA radiographs. The purpose of this study was to assess chest PA and CT features of these patients. MATERIALS AND METHODS: All chest PA radiographs and CT scans in 9 patients were reviewed by two radiologists on a consensus basis; for the presence of pleural effusion, pulmonary edema and heart size on chest PA radiographs. For the portion of the fluid collection in the superior aortic recess (SAR), a connection between the right lateral portion of the SAR (rSAR) and posterior portion of the SAR (pSAR) on CT scans, and the distance between the right lateral margin of the rSAR and the right lateral margin of the superior vena cava. RESULTS: Fluid collection in the rSAR on CT scans caused a right anterior mediastinal mass or a bulging contour on chest PA radiographs in all women patients. All patients showed cardiomegaly, five patients had pleural effusion, and two patients had mild pulmonary edema. Further, eight patients showed a connection between the rSAR and the pSAR. CONCLUSION: The characteristic features of these patients are the right anterior mediastinal mass-like opacity due to fluid collection in the rSAR, are bulging contour with a smooth margin and cardiomegaly regardless of pulmonary edema on the chest PA radiographs, and fluid connection between the rSAR and the pSAR on CT scans.
Aged ; Aged, 80 and over ; Aorta, Thoracic/*radiography ; Cardiomegaly/radiography ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Female ; Humans ; Mediastinal Diseases/*radiography ; Middle Aged ; Pleural Effusion/*radiography ; Pulmonary Edema/*radiography ; Radiography, Thoracic/*methods ; Retrospective Studies ; Tomography, X-Ray Computed/*methods

OBJECTIVE: To evaluate perinatal outcomes in patients with abnormal 50 gm challenge test followed by normal 100 gm oral glucose tolerance test (OGTT) value. METHODS: We examined the pregnancy outcomes of 423 women classified as the study group with abnormal 50 gm oral glucose challenge test (OGCT) followed by normal 100 gm OGTT based on NDDG criteria. If the 1-hour plasma glucose value of 50 gm OGCT was over 130 mg/dL, the patient was scheduled for a full 3-hour 100 gm OGTT. 50 gm OGCT and 100 gm OGTT were administered at 24-28 and 28-32 weeks' gestation, respectively. The control group constituted of 467 age- and body mass index (BMI)-matched negative screenees. We defined poor maternal outcomes as those suffering from any one of hydramnios or oligohydramnios, preeclampsia, cesarean delivery due to cephalopelvic disproportion, dystocia, or fetal distress. We also defined poor neonatal outcomes as those suffering from any one of hyperbilirubinemia, hypoglycemia, congenital anomaly, admission to neonatal intensive care unit due to respiratory distress syndrome, or perinatal mortality. Retrospective review of outcomes of these patients was performed. Student t-test, Fisher's exact test and chi-square test were used to determine the statistical significance. RESULTS: There were no significant differences in demographic and obstetric characteristics between the control group and the study group. There were no significant differences in gestational age (38.7+/-1.5 vs 38.5+/-1.5 weeks), birth weight (3189.2+/-420.9 vs 3236.7+/-423.1 gm), between the groups. And there were no significant differences in preterm birth (6.2% vs 7.4%), large for gestational age births (4.5% vs 5.0%), intrauterine growth restriction (5.4% vs 4.3%) between the groups. There were no significant differences in poor maternal outcomes (15.6% vs 18.7%) and poor neonatal outcomes (3.9% vs 5.7%) between the groups. CONCLUSION: We conclude that abnormal value on 50 gm challenge test followed by normal 100 gm OGTT is not associated with adverse perinatal outcomes.
Birth Weight ; Blood Glucose ; Body Mass Index ; Cephalopelvic Disproportion ; Dystocia ; Female ; Fetal Distress ; Gestational Age ; Glucose ; Glucose Tolerance Test* ; Humans ; Hyperbilirubinemia ; Hypoglycemia ; Infant, Newborn ; Intensive Care, Neonatal ; Oligohydramnios ; Parturition ; Perinatal Mortality ; Polyhydramnios ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Retrospective Studies

OBJECTIVE: The purpose of this study was to evaluate the efficacy and toxicity of concurrent chemor- adiotherapy (CCRT) in loco-regionally advanced cervical cancer patients. METHODS: The medical records of 24 patients were retrospectively reviewed who underwent CCRT' and 62 patients who had underwent radiation therapy alone at the Department of Obstetrics and Gynecology, Ajou University Hospital from September, 1994 to August 2000 for loco-regionally advanced cervical cancer (stage IIb-IVa and Ib-IIa with bulky tumor mass or pelvic lymph node involvement detected by magnetic resonance imaging). Radiotherapy was performed for 7 weeks during which the patients underwent radiotherapy and chemotherapy concomitantly. Chemotherapeutic regimen consisted of cisplatin (75 mg/m2 on day 1, 4) and 5-FU (1000 mg/m2 on day 2-5, 30-33). The toxicity was assessed according to the GOG toxicity criteria. RESULTS: In the CCRT group, 2 of 18 patients (11.1%) had recurrent disease. Of the 22 patients who were followed up, the overall survival rate was 83.3%, and the relapse-free survival rate was 89.9%. In the radiotherapy alone group, 19 of 61 patients (32.3%) had recurrent disease. Of the 62 patients who were followed up, the overall survival rate was 75.4% and the relapsed-free survival rate was 67.7%. Relative risk reduction rate of the death rate in the CCRT group was 66% (RR 0.34), and 32% (RR 0.68) in the recurrence rate. Acute toxicities in the CCRT group were enteritis grade 3:3 (12.5%), leukopenia grade 3:2 (8.3%), anemia grade 3:1 (4.1%) and grade 4:2 (8.3%). The acute toxicities in the radiation therapy alone group were enteritis grade 3:7 (11.3%), rectal bleeding grade 3:1 (1%). Increased acute toxicities developed in the CCRT group. CONCLUSION: This study shows improved overall survival rates and relapse-free survival rates but some increase in acute toxicity. It is suggested that CCRT be the standard treatment of loco-regionally advanced cervical cancer. Due to small size sample and short duration of follow up, further study of a large group of patients and the long term survival rate are necessary.
Anemia ; Chemoradiotherapy* ; Cisplatin ; Drug Therapy ; Enteritis ; Fluorouracil ; Follow-Up Studies ; Gynecology ; Hemorrhage ; Humans ; Leukopenia ; Lymph Nodes ; Medical Records ; Mortality ; Obstetrics ; Radiotherapy ; Recurrence ; Retrospective Studies ; Risk Reduction Behavior ; Survival Rate ; Uterine Cervical Neoplasms*

BACKGROUND/AIMS: To evaluate the prognostic impact of the lymph node ratio (LNR: the ratio of positive lymph nodes to the total number of lymph nodes examined) on disease recurrence and survival among rectal cancer patients who received curative surgery and postoperative chemoradiotherapy (CRT). METHODS: Between 1995 and 2008, 124 patients with pathologic T3-4 or node-positive rectal cancer underwent curative surgery and postoperative CRT. Postoperative radiotherapy was delivered at a median dose of 50.4 Gy (range, 45 to 59.4 Gy) for 6 weeks. Chemotherapy consisted of a bolus injection of 5-fluorouracil and leucovorin in the first and last week of radiotherapy (91.9%) or daily capecitabine during radiotherapy (8.1%). Further adjuvant chemotherapy was administered after chemoradiation. RESULTS: The median follow-up was 5.1 years. In the multivariate analysis, pathologic N (pN) stage and lymphovascular invasion were significantly associated with disease-free survival and disease-specific survival (p<0.05). However, when the LNR with a cutoff value of 0.2 was included as a covariate in the model, the LNR was highly significant (p<0.001), and the pN stage lost its significance (p>0.05). CONCLUSIONS: The LNR predicts recurrence and survival more accurately than pN stage. The pN stage and the LNR should be considered together when estimating the risk of disease recurrence among rectal cancer patients.
Chemoradiotherapy ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Deoxycytidine ; Disease-Free Survival ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Lymph Nodes ; Multivariate Analysis ; Rectal Neoplasms ; Recurrence ; Capecitabine