Rotation-plasty procedure was first done by Borggreve, in 1930 for the congenital short femur. Recently this procedure was used for the malignant bone tumor at the distal femur by Kotz and Salzer in 1982. In spite of its cosmetic problem of the distal stump, this procedure has great functional advantage of converting the above-knee amputation to the below-knee amputation. The authors applied this procedure in case of severe soft tissue crushing and large bone defect from the distal femur to the proximal tibia by the rail-road accident. Conventional below-knee prosthesis with thigh corset gave him normal ambulation. The inverted foot was good to control the prosthesis as a below-knee stump and heel functioned as a patella to support the body weight.
Amputation ; Body Weight ; Femur ; Foot ; Fractures, Comminuted ; Heel ; Knee ; Patella ; Prostheses and Implants ; Thigh ; Tibia ; Walking

Objective: This study investigated the association between white matter tract integrity and frontal executive function in adult non-geriatric patients with major depressive disorder (MDD) and healthy controls (HCs) using diffusion tensor imaging (DTI). Methods: In total, 57 patients with MDD and 115 HCs participated in this study. We calculated the integrity of the white matter tracts using the Tracts Constrained by Underlying Anatomy tool (TRACULA) from FreeSurfer. We performed cognitive function tests. Oneway analysis of covariance was used to investigate the DTI parameters as dependent variables; diagnosis of MDD as an independent variable; and age, sex, and education level as covariates. For correlation analysis between the DTI parameters and cognitive function tests, Pearson’s partial correlation analyses were performed in the MDD and HC groups. Results: The patients with MDD showed significantly decreased axial diffusivity (AD) in forceps major (FMajor), left corticospinal tract (CST), left superior longitudinal fasciculus-parietal bundle (SLFP), right anterior thalamic radiation (ATR), right CST, right inferior longitudinal fasciculus (ILF) and right superior longitudinal fasciculus-temporal bundle (SLFT) and mean diffusivity (MD) in the left CST, right CST, and right SLFT compared to HCs. We found that non-geriatric patients with MDD showed a significant negative correlation between the response time in the Stroop task and the AD value of the FMajor. Conclusion Our findings suggest that impaired structural connectivity in the FMajor may be associated with cognitive dysfunction in non-geriatric patients with MDD.

Ludwig's angina is a progressive gangrenous cellulitis and edema of the soft tissues of the neck and floor of the mouth. Ludwig's angina can be fatal as a result of progressive swelling of the soft tissues of the neck and elevation and posterior displacement of the tongue, resulting in airway obstruction. We report the case of a 77-yearold man who was admitted to the dental hospital with a toothache and headache. He was diagnosed with left submandibular space abscess. Four days post-admission, the submandibular and submental abscess was incised and drained. After the operation, the patient suddenly developed dyspnea and suffered cardiopulmonary arrest and died. An autopsy was performed, and exploration of the neck revealed a submental and submandibular abscess with massive inflammation, edema, and an abscess in multiple layers of the cervical subcutaneous tissue. After autopsy, the cause of death was confirmed as Ludwig's angina with a deep neck abscess. Ludwig's angina is a rapidly progressive cellulitis that often results in death by asphyxia or sepsis and is rarely seen in a forensic autopsy practice. Here in we report a case of Ludwig's angina and present a review of the literature.
Abscess ; Airway Obstruction ; Asphyxia ; Autopsy* ; Cause of Death ; Cellulitis ; Dyspnea ; Edema ; Headache ; Heart Arrest ; Humans ; Inflammation ; Ludwig's Angina* ; Mouth ; Neck ; Sepsis ; Subcutaneous Tissue ; Tongue ; Toothache

C-Reactive protein (CRP) is an acute phase response protein synthesized in the liver as a response to various inflammation. CRP is extensively used as a general marker for inflammation in clinical medicine. A forensic applications of the CRP using postmortem samples have been studied in oversea. We have compared CRP in the between antemortem and postmortem samples and studied stability of postmortem blood samples for CRP test. In 69 consecutive autopsy cases, we have analysed heart blood samples (69 cases), peripheral blood samples (33 cases), and vitreous humor samples (60 cases). Postmortem CRP was elevated in 25 cases (36.2%) and possible causes of CRP elevation were inflammatory disease except one case (unknown). Postmortem CRP test shows sensitivity 86.7%, specificity 80%, positive predictive value 92.9%, and negative predictive value 66.7% for inflammation based on 20 cases with antemortem CRP results. The postmortem CRP levels were similar in the heart blood samples and peripheral blood samples. Vitreous humor samples are not useful in postmortem CRP testing. And both whole blood and serum samples are stable in room temperature until 31 days. We conclude that serum from heart blood is best suitable sample for postmortem CRP test and postmortem CRP test is useful in routine autopsy practice to detect inflammatory disease such as sepsis. From the view of postmortem point, we desire that this valuable test should be used in routine autopsy practice in Korea.
Autopsy* ; C-Reactive Protein* ; Clinical Medicine ; Forensic Medicine ; Heart ; Inflammation ; Korea ; Liver ; Sensitivity and Specificity ; Sepsis ; Vitreous Body

In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure.
Aged ; Carotid Arteries/diagnostic imaging ; Cerebrovascular Circulation/*physiology ; Dizziness/etiology ; Female ; Hemodynamics/*physiology ; Humans ; Kidney Failure, Chronic/*physiopathology ; Male ; Middle Aged ; Renal Dialysis ; Risk Factors ; Ultrasonography, Doppler, Duplex

In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure.
Aged ; Carotid Arteries/diagnostic imaging ; Cerebrovascular Circulation/*physiology ; Dizziness/etiology ; Female ; Hemodynamics/*physiology ; Humans ; Kidney Failure, Chronic/*physiopathology ; Male ; Middle Aged ; Renal Dialysis ; Risk Factors ; Ultrasonography, Doppler, Duplex

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated progressive or relapsing demyelinating peripheral neuropathy. Other autoimmune diseases may be associated with CIDP. A 38-year-old man developed CIDP, which was subsequently associated with membranous glomerulonephritis (MGN) and tendinitis. He was treated with intravenous immunoglobulin, rituximab, and prednisone, which resulted in improvement of the clinical symptoms. This is a case report of CIDP associated with MGN and tendinitis.
Adult ; Autoimmune Diseases ; Glomerulonephritis ; Glomerulonephritis, Membranous* ; Humans ; Immunoglobulins ; Peripheral Nervous System Diseases ; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating* ; Prednisone ; Rituximab ; Tendinopathy*

PURPOSE: This study was done to analyze how a death preparation education program have the effects on awareness of hospice palliative care and withdrawing life sustaining treatment in older adults. METHODS: This study employed a non-equivalent control group design among quasi-experimental designs. The experimental group was comprised with 35 adults and the control group with 40 adults. The death preparation program consisted of five two-hour sessions and was administered once a week for five straight weeks. Data were analyzed by descriptive statistics, t-test, chi2 test, Fisher's exact test, and ANCOVA using SPSS version 18.0. RESULTS: The mean age of the participants was 66.2 years. A significant difference between the experimental and control groups was observed in withdrawing life sustaining treatment (F=3.380, P=0.040). However, no significant difference was found in awareness of hospice palliative care (F=0.163, P=0.850). CONCLUSION: The study results indicate that death preparation training could positively affect people's awareness of withdrawing life sustaining treatment. More studies should be conducted to explore effects of death preparation education for all ages and help people better understand hospice palliative care.
Adult ; Education* ; Hospices* ; Humans ; Life Support Care ; Palliative Care*

BACKGROUND: Serotonin transporter gene-linked polymorphism region(5-HTTLPR) and catechol-O-methyltransferase(COMT) genes are thought to be important factors in some personality traits and the etiology of anxiety disorder. The goal of this study was to determine the role of these genes in personality traits. METHOD: The participants included 116 healthy adults with no history of psychiatric disorders and other physical illness for the last 6 months. All participants were tested by Temperament and Character Inventory(TCI). The 5-HTTLPR, COMT val158met gene polymorphisms were analyzed with PCR(Polymerase Chain Reaction). Differences on TCI dimensions and sub-scales among groups were examined with t-test and ANOVA. RESULT: There were possible relationships of the 5-HTTLPR with self-transcendence(P=0.050) and COMT val158met polymorphism with cooperativeness(P=0.053). CONCLUSION: We found associations between 5-HTTLPR, COMT polymorphisms and the some TCI character dimensions. Further studies of polymorphisms of other genes and their interactions may clarify the complex relationship between personality and genes.
Adult ; Anxiety Disorders ; Humans ; Polymorphism, Genetic ; Serotonin Plasma Membrane Transport Proteins ; Temperament

It is customary that the dizziness related to cerebral perfusion might be caused by insufficient posterior circulation. The occurrence and nature of dizziness originating from anterior circulation has not been well-known. Here, we report a chronic dizzy woman presenting with severe internal carotid artery stenosis, which improved after carotid artery stenting.
Carotid Arteries ; Carotid Artery, Internal ; Carotid Stenosis ; Dizziness ; Female ; Humans ; Perfusion ; Stents