If the replantation on the original position is not possible, the amputated tissue of a hand may be used as a donor for recovering hand functions at other positions. This procedure is termed 'heterodigital replantation'. An 63-year-old male patient who was in press machine accident came to our hospital. He had large dorsal soft-tissue defects (5x3 cm) on his left long finger and complete amputation on his left index finger through the proximal interpharyngeal joint. Replantation was not indicated because crushing injury of index finger was severe. So we decided to use index finger soft tissue as heterodigital free flap for the coverage of the long finger defect. The ulnar digital artery and dorsal subcutaneous vein of the free flap were anastomosed with the radial digital artery and dorsal subcutaneous vein of the long finger. The heterodigital free flap provided satisfactory apperance and functional capability of the long finger. The best way to treat amputation is replantation. But sometimes surgeon confront severely crushed or multi-segmental injured amputee which is not possible to replant. In this situation, reconstructive surgeons should consider heterodigital free flap from amputee as an option.
Amputation ; Amputees* ; Arteries ; Fingers* ; Free Tissue Flaps* ; Hand ; Humans ; Joints ; Male ; Middle Aged ; Replantation ; Tissue Donors ; Veins

The long arm duplication of chromosome 3 was reported for the first time in 1966 by Falek et al., and Hirschhorn et al. came to identify the duplication of 3q21--> qter region in 1973. In most cases of duplication 3q syndrome patients, pure duplication of 3qter is believed to be rare and is often reported accompanied with deletion of another segment of the chromosome. Approximately 75 percent of parents of the patient in the meantime have been demonstrated to have unbalanced translocations or inversions of the chromosome. Partial deletion of the distal part of the short arm of chromosome 3 was first reported by Verjaal and De Nef in 1978 and terminal deletion of chromosome 3 (3p25- qter) has been observed in most cases. In karyotyping of chromosomes of immature infants showing the manifestations of flat occiputs, low set ears, hypertelorism, broad nasal roots, thin lips, web necks, hypotonia, hypertrichosis skin, cryptorchidism etc, we experienced a case diagnosed as 46, XY, rec (3) dup (3) (q21) del (3) (p25) inv (3) (p25q21).
Infant ; Male ; Female ; Humans

The antisynthetase syndrome is characterized by anti-Jo-1 antibody production, interstitial lung disease, inflammatory muscle disease, and, in many cases, fever, polyarthritis, Raynaud's phenomenon, and mechanic's hands. Joint signs and symptoms occur in up to 90% of patients with antisynthetase syndrome, occasionally as the initial manifestations. Although visual inspection of the hands shows changes that are highly suggestive of rheumatoid arthritis, notable differences exist. Antisynthetase syndrome is a predominantly nonerosive arthropathy with subluxations of the distal interphalangeal joints. It manifests as overlap syndrome with other connective tissue diseases. However, overlap syndrome of antisynthetase syndrome and rheumatoid arthritis is rare. We treated a 51-year-old male patient with overlap syndrome of antisynthetase syndrome and rheumatoid arthritis, and report the case with a review of the literature.
Antibodies, Antinuclear ; Antibody Formation ; Arthritis ; Arthritis, Rheumatoid ; Connective Tissue Diseases ; Fever ; Hand ; Humans ; Joints ; Lung Diseases, Interstitial ; Male ; Middle Aged ; Myositis ; Polymyositis

BACKGROUND: Burn injuries of the extremity can result in cosmetically offensive appearance. Postburn scar can improve by the combination of tangential excision and thin split-thickness skin graft. METHODS: From January 2005 and December 2012, 17 patients (10 males and 7 females) with postburn scar of the extremity underwent the combined techniques. The median time from initial injury to surgery was 66.2 months (range: 11-288 months). In the operation, burn scar was excised until viable dermis could be observed using electrical dermatome, after which thin split thickness skin graft was performed. RESULTS: Tangential excision and thin split thickness skin graft gave excellent grafting results without the need of reoperation. Depigmentation in the majority of patients were recovered within a year by the operation of thin split thickness skin graft. Recovery of range of motion and cosmetic results were good in all patients. CONCLUSIONS: Tangential excision and thin split thickness skin graft are a good way of the reconstruction of deformed and depigmented skin from burns on extremity.
Burns* ; Cicatrix* ; Dermis ; Extremities ; Humans ; Male ; Range of Motion, Articular ; Reoperation ; Skin* ; Transplants*

BACKGROUND: Among facial fractures, nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture take a large portion. Among surgical operations for nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture, closed reduction has been generally used but, unlike open reduction, there is a problem in evaluating its accuracy of reduction. METHODS: An assessment was made from October 2011 until April 2013 prospectively on 37 patients. For all the operations, closed reductions were executed in a conventional way and simultaneously using C-Arm to verify the reduction of fractures. Two images of plain radiography, one taken before operation and another one taken one day after the operation, were compared. After obtaining images of plain radiography using C-Arm immediately after the correction upon operation, they were compared with the images of plain radiography taken one day after the operation. RESULTS: The fracture reductions of 26 patients among 27 nasal fracture patients were satisfactory but one patient showed a marginal overcorrection of less than 1 mm. The fracture reductions of 7 patients among 8 zygomatic arch fracture patients were satisfactory but one patient showed a marginal undercorrection of less than 2 mm. All of two mandibular subcondyle fracture patients showed less than 2 mm undercorrection. CONCLUSION: Closed reduction guided by C-Arm for nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture was clinically useful because it could make a real-time assessment on fractured areas and add immediate corrections during the operation.
Facial Bones* ; Fluoroscopy* ; Fractures, Closed ; Humans ; Mandible ; Nasal Bone ; Prospective Studies ; Zygoma ; Zygomatic Fractures

In 1974, Casson et. al. reported midfacial degloving approach to repair the midfacial bone fracture. After then, this approach has been used frequently to treat the lesions on nasal cavity, nasopharynx, facial plastic surgery and midfacial trauma. Midfacial degloving approach consists of 1) bilateral sublabial incision 2) complete transfixion incision/ septocolumellar incision 3) bilateral intercartilaginous incision 4) bilateral pyriform aperature incision. This approach provides proper access for midfacial bone structure without facial scar but has post-operative complications such as transient epistaxis, infraorbital nerve paresthesia and nasal crust. We treated three patients using midfacial degloving approach to correct traumatic deformity in midface area. In two patients, rhinoplasty with autogenous rib graft was done simultaneously. So we report these cases with review of literatures.
Cicatrix ; Congenital Abnormalities ; Epistaxis ; Fractures, Bone* ; Humans ; Nasal Cavity ; Nasopharynx ; Paresthesia ; Rhinoplasty ; Ribs ; Surgery, Plastic ; Transplants

We report a case of Rumpel-Leede (RL) phenomenon, - acute dermis capillary rupture, secondary to noninvasive blood pressure (NIBP) monitoring in a patient with type 2 diabetes mellitus (DM) and hypertension. The first most likely cause is vascular fragility in microangiopathy as a result of DM and chronic steroid use. The second is the increased venous pressure during cycling of the blood pressure cuff in a hypertensive state. Anesthesiologists need to be aware that acute dermal capillary rupture, although rare, can occur in patients with long-standing DM, hypertension and chronic steroid use.
Blood Pressure ; Capillaries ; Dermis ; Diabetes Mellitus, Type 2 ; Humans ; Hypertension ; Rupture ; Venous Pressure

PURPOSE: The purpose of this study was to identify the relationships between life style, menstrual attitude and premenstrual syndrome in nursing students. METHODS: The study participants were 246 nursing students of a university in Gyeunggi province. Data were collected by a self-administered questionnaire from May to June, 2012. Collected data were analyzed using the SPSS/WIN 20.0 program with descriptive statistics, Pearson correlation coefficient, t-test, one-way ANOVA and Scheffe test. RESULTS: Students who had undesirable alcohol habits (r=.15, p=.020) and negative menstrual attitude (r=.17, p=.009) experienced more a severe premenstrual syndrome (PMS). Students with dysmenorrhea had more severe PMS (F=12.41, p<.001) and a negative menstrual attitude (F=6.18, p<.001). CONCLUSION: These finding suggest that PMS would be alleviated by nursing interventions to improve alcohol habits and decrease negative menstrual attitudes, and nursing interventions for dysmenorrhea would be helpful in PMS management in nursing students. Further studies on the development of nursing interventions related to these factors are needed for PMS management.
Dysmenorrhea ; Female ; Humans ; Life Style ; Menstruation ; Premenstrual Syndrome ; Surveys and Questionnaires ; Students, Nursing

Diabetic neuropathy is one of the most common complications of diabetic mellitus and has myriad clinical presentations. Amitriptyline is an effective drug for painful diabetic neuropathy, but has a wide variety of cardiovascular effects. We report a case of amitriptyline-induced ventricular tachycardia in a patient with painful diabetic neuropathy. A 48-year-old man with no history of heart disease was treated with amitriptyline for the past 2 months. The dosage of this drug was gradually increased and the maximal dose was 170 mg per day. Prior to administration of this drug, his chest X-ray and electrocardiogram were normal. On admission he complained of chest discomfort and palpitation for 3 days, but his vital sign was stable. The electrocardiogram showed a wide QRS complex with a rate of 170 beats per minute. The ventricular tachycardia was successfully treated with electrical cardioversion.
Amitriptyline* ; Diabetic Neuropathies* ; Electric Countershock ; Electrocardiography ; Heart Diseases ; Humans ; Middle Aged ; Tachycardia, Ventricular* ; Thorax ; Vital Signs

The most common finding related to nonalcoholic steatohepatitis is obesity, but a status of severe malnutrition can also induce the steatohepatitis. The authors report a rare case of steatohepatitis leading to hepatic decompensation caused by malnutrition after pancreaticoduodenectomy. A 68-year-old female patient who had been previously diagnosed with pancreatic cancer and had undergone pancreaticoduodenectomy 5 months previously presented with abdominal distension. Routine CT performed 3 months after the surgery revealed severe fatty liver without evidence of tumor recurrence. After undergoing pancreaticoduodenectomy her food intake had reduced, and as a result she had lost 7 kg of body weight over 2 months. At this admission, CT revealed moderate amounts of ascites without tumor recurrence. Furthermore, her albumin and lipid profile levels were markedly decreased, and she had a flapping tremor and slurred speech suggestive of hepatic encephalopathy. Her liver biopsy findings were consistent with steatohepatitis and disclosed macrovesicular steatosis without definite fibrosis. After careful nutritional control, her symptoms disappeared and her laboratory findings improved.
Aged ; Ascites/etiology ; Fatty Liver/*diagnosis/etiology/pathology ; Female ; Humans ; Liver Function Tests ; Malnutrition/*complications ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy ; Tomography, X-Ray Computed