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

PURPOSE: The purpose of this study was to survey the prevalence rate of cognitive impairments and to identify the factors influencing cognitive impairment in the elderly in rural communities of Jeju Province. METHODS: 590 elderly in 6 rural communities of Jeju Province were interviewed, using a questionnaire consisting of sociodemographic characteristics, health behavior, quality of life, and MMSE-K RESULTS: Prevalence of cognitive impairment was 33.1% (39.1% of females, 16.76% of males). Prevalence of dementia was 12.4% (16.3% of females, 2.87% of males). Factors related to cognitive impairment were age, sex, education, standard of living, employment status, and subjective health state. CONCLUSIONS: In community health care for the elderly, factors relating to cognitive impairment have to be considered. When planning community health care, priority should be given to the elderly; who need care but live alone; who lack social support; who have a low standard of living; who experience discomfort in the activities of daily living; who believe they are not in a good state of health; or whose life satisfaction is low.

A 53-year-old woman presented with dyspnea. She had undergone extended thymectomy for an invasive thymoma two months prior. CT revealed numerous small nodules in the lung. After that, she deteriorated owing to acute respiratory distress syndrome (ARDS), and the vascular surgeon planned veno-venous extracorporeal membrane oxygenation (ECMO). During percutaneous cannulation through the left femoral vein, a vascular injury was suspected, and the patient’s vital signs became unstable. Diagnostic angiography showed a ruptured left common iliac vein, and the bleeding was stopped by placement of a stent-graft. May-Thurner syndrome was diagnosed on abdominal CT. Here, we report a rare case of ECMO-related vascular injury in a patient with an unrecognized anatomical variant, May-Thurner syndrome.

OBJECTIVE: To compare the visibility and procedural parameters between a standard spinal needle and a new laser-etched needle (LEN) in real-time ultrasonography guided lumbar medial branch access in a phantom of the lumbosacral spine. METHODS: We conducted a prospective single-blinded observational study at a rehabilitation medicine center. A new model of LEN was manufactured with a standard 22-gauge spinal needle and a laser etching machine. Thirty-two inexperienced polyclinic medical students performed ultrasonography-guided lumbar medial branch access using both a standard spinal needle and a LEN with scanning protocol. The outcomes included needle visibility score, needle elapsed time, first-pass success rate, and number of needle sticks. RESULTS: The LEN received significantly better visibility scores and shorter needle elapsed time compared to the standard spinal needle. First-pass success rate and the number of needle sticks were not significantly different between needles. CONCLUSION: A new LEN is expected to offer better visibility and enable inexperienced users to perform an ultrasonography-guided lumbar medial branch block more quickly. However, further study of variables may be necessary for clinical application.
Humans ; Needles* ; Needlestick Injuries ; Observational Study ; Phantoms, Imaging ; Prospective Studies ; Rehabilitation ; Spine ; Students, Medical ; Ultrasonography ; Zygapophyseal Joint

No abstract available.
DNA* ; Plasmids* ; Restriction Mapping* ; Yersinia enterocolitica* ; Yersinia*

A nested polymerase chain reaction (PCR) was applied to detect and identify pathogenic Yersinia enterocolitica and Y. pseudotuberculosis. We used photochemical postamplification procedure with 8-methoxypsoralen to control carryover contamination. Using the ail and inv gene, the sensitivity and specificity of DNA amplification by nested PCR was considerably improved. The amplified fragment sizes were 298 bp for the ail gene and 295 bp for the inv gene. Amplification was successful when the template was derived from three sources: purified DNA, aliquots of boiled bacterial suspension and aliquots of lysed bacterial suspension. The detection limits were 10 fg of DNA and 2 * 10 colony forming units (CFU) for Y. enterocolitica and 10 fg DNA and 2 CFU for Y. pseudotuberculosis.
DNA ; Limit of Detection ; Methoxsalen ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Stem Cells ; Yersinia enterocolitica* ; Yersinia pseudotuberculosis* ; Yersinia*

STUDY DESIGN: A retrospective analysis of the patients who had cauda equina syndrome caused by a herniated lumbar disc. OBJECTIVES: To assess the clinical debates concerning the diagnosis, treatment, and results of treatment. SUMMARY OF LITERATURE REVIEW: This syndrome has been considered as an absolute indication of surgical treatment in the herniated lumbar disc and poor prognosis after surgery were reported. Although there are debates on the timing of surgery, early recognition early surgical treatment are recommended for a better results of treatment. MATERIALS AND METHODS: 23 consecutive patients having a cauda equina syndrome caused by herniated lumbar disc were reviewed retrospectively. They were 14 males and 9 females having ages of 41.6 in average. The incidence of this syndrome was 3.8% of the patients who had surgical treatment of herniated lumbar disc. RESULTS: All patients had bladder dysfunction in addition to the low back pain and radicular pain in the leg, but five patient did not recognize their urinary retention which were shaded by severe leg pain. A surgical treatment were performed for all patients at 6.8 days in average after onset of the bladder dysfunction. At follow-up of 3 years and 3 months in average after surgery, 20 patients(86.9%) had satisfactory resolution of the low back pain and leg pain, and all patients had complete recovery of motor weakness except one patients who had residual foot drop. Bladder function recovered satisfactorily in 18 patients (78.3%), but 4 patients had some difficulty of urination and one patient needed a sphinterotomy for urination. CONCLUSIONS: The cauda equine syndrome in herniated lumbar disc was often not recognized early and a poor result of treatment was not rare, particularly in the patients who had acute onset and severe bladder dysfunction. So, early diagnosis and active surgical treatment are recommended for a better results of treatment.
Cauda Equina* ; Diagnosis ; Early Diagnosis ; Female ; Follow-Up Studies ; Foot ; Humans ; Incidence ; Leg ; Low Back Pain ; Male ; Polyradiculopathy* ; Prognosis ; Retrospective Studies ; Urinary Bladder ; Urinary Retention ; Urination

No abstract available.
Genes, ras* ; Humans*

No Abstract Available.
Hair*

From 1986 to 1995, 75 eyes of 75 patients who were admitted with a diagnosis of infectious corneal ulcer at Chunbuk university hospital were analyzed on the etiologic agents and clinical findings. Etiologic agents of infectious corneal ulcer were classified as 49 bacterial ulcers(65.3%) and 26 fungal ulcers(34.7%). The most common isolated bacteria was 8 cases of coagulase negative staphylococcus and pseudomonas species was the most common isolated gram negative organism. Candida species was the most commonly isolated fungus. Hypopyon was noted in 30 cases(40%) of infectious corneal ulcers, 14 cases in small ulcer group and 16 cases in large ulcer group. There was no difference between severity and presence of hypopyon of the 75cases (P>0.05. chi-square test).
Bacteria ; Candida ; Coagulase ; Corneal Ulcer* ; Diagnosis ; Fungi ; Humans ; Pseudomonas ; Staphylococcus ; Ulcer